Record enrollment numbers send a clear message about health care affordability, access 

As the Senate mulls action of Build Back Better, 14.5 million people across America have already voiced their support for more affordable health coverage through record-breaking enrollment in Affordable Care Act (ACA) marketplace plans during this year’s open enrollment. Announced last week, this figure shatters the previous enrollment record of 12.6 million in 2016. And though the economic fallout from COVID-19 pandemic created a greater need for accessible marketplace insurance, unemployment numbers are back near pre-pandemic totals. This points to a different driver of this record enrollment that should guide the president and Congress in Build Back Better negotiations: more affordable coverage and assistance make a huge difference in people’s lives.  

Thanks to the American Rescue Plan Act’s (ARPA) boost in premium tax credits, marketplace shoppers saw premiums drop by an average of 23 percent. This means a 35-year-old mother of two in Allentown, Pa., making $45,000 a year pays $83 a month for health care premiums, compared to the $254 per month she would have paid without the enhanced tax credit. A 46-year-old father of one in Flagstaff, Ariz., who earns $34,000 annually and was paying $181 per month for premiums, now pays only $60. These savings can be redirected toward other life essentials such as child care, rent and food. Most importantly, these families and individuals now have access to the preventive care, treatment for long-term illnesses, and prescription drug therapies they’ve been waiting for, without going into medical debt. 

But as a non-profit that has partnered with state and community-based organizations across the country to support enrollment work since the ACA’s passage, we know that cheaper plans were not the only factor driving people to enroll in health coverage. Equally important was the Biden administration’s unprecedented $80 million investment in outreach, education and enrollment support, with an emphasis on helping underserved communities of color and rural areas. After years of anemic support for enrollment by the Trump administration that left many in the dark about the enrollment period and the availability of subsidized coverage, this level of support was a game-changer. 

Enrolling in health insurance is a complex process. Consumer Assistance Programs (CAPs), Navigators, and community-based organizations are uniquely equipped to help as trusted entities that offer people a wide range of services in their own language, from education to enrollment support to appeals. This free, unbiased assistance comes from people who are often representative of the diverse communities in which they live and work. This is particularly important for historically excluded Black, brown and Indigenous people and those living in rural communities, who have long faced unfair and often discriminatory barriers in accessing health coverage and care. 

Build Back Better would also close a major hole in health coverage and a glaring racial injustice, the Medicaid coverage gap. More than 2 million people living in 12 states have been denied affordable health coverage through Medicaid when they lost jobs or became sick, even during the pandemic, because their states have refused to expand Medicaid. Because of barriers for Black and brown people to job opportunities that provide health coverage, over 60 percent of people in the coverage gap are people of color. 

The need for affordability measures, coverage expansion, and help enrolling in and maintaining coverage will not be a one-off. The 14.5 million people who took advantage of marketplace plans with increased tax credits and lower deductibles will expect that affordable coverage to continue beyond the pandemic. And polling shows that reducing health care costs is a top priority for voters, regardless of political affiliation.  

This should underscore the importance of passing Build Back Better and ensuring these resources remain available in the future. A five-year extension on the tax credits, additional navigator funding should Congress finally close the Medicaid coverage gap, and $100 million for CAPs, which haven’t been funded since 2012, over the next four years will go far in ensuring people obtain, make sense of and effectively use their health coverage. 

Both the polls and the enrollment numbers send a clear message to Washington lawmakers: people need affordable health care. By advancing this trifecta of policies — boosting the premium tax credits, closing the Medicaid coverage gap and deeper support for organizations helping people in their own community gain coverage, President Biden and Congress begun unlocking the door to affordable health coverage and care for millions. Now they need fully open it by passing Build Back Better.  

Emily Stewart is executive director of Community Catalyst, a non-profit organization dedicated to advancing a movement for health equity and justice.