Economy
40 Million on the ACA — The Record Nobody in Washington Wants to Discuss
Marketplace enrollment hit 21.3M for 2026 coverage. Add Medicaid expansion and CHIP: over 40M Americans depend on the ACA. Elena V. reports.
Open enrollment for 2026 coverage closed with 21.3 million Americans signing up through the ACA marketplaces — a record for the sixth consecutive year.
The full picture
The marketplace number is only part of it. Medicaid expansion under the ACA covers another 21 million adults. CHIP covers 7 million children. Total: over 40 million Americans get their health coverage through the law Obama signed in March 2010.
Why the enrollment keeps growing
The enhanced premium subsidies from the American Rescue Plan and the IRA extended those subsidies through 2025. They're now scheduled to expire at end of 2025 without congressional action. Every year the enrollment rises, the political cost of letting them lapse rises with it.
The state gap
The ten states that still refuse Medicaid expansion (Texas, Florida, Mississippi, Alabama, Georgia, Tennessee, Kansas, South Carolina, Wisconsin, Wyoming) have 4.4 million adults in the coverage gap — too poor for marketplace subsidies, ineligible for their state's Medicaid.