A record 20.4 million Americans have signed up for Affordable Care Act plans since open enrollment began in November. Sign-ups are expected to continue to grow.

  • A record 20.4 million Americans have signed up for Affordable Care Act plans since open enrollment began in November
  • It’s the third consecutive year of ACA gains. Sign-ups are expected to continue growing before open enrollment closes on Jan. 16, given there’s usually a spike in enrollment before the deadline
  • More than 3.7 million people who enrolled for 2024 are new to the ACA exchanges, representing almost a fifth of total sign-ups

The ACA has already been a flashpoint in the 2024 presidential election race, with President Joe Biden touting his record in increasing insurance coverage through the law. Meanwhile, Donald Trump, the current frontrunner for the Republican candidacy, has pledged to repeal and replace the law if he regains the White House.

The ACA was passed over a decade ago and created new federal and state marketplaces for health insurance, among other reforms. ACA sign-ups have bloomed over the pandemic, due in part to more generous federal subsidies making the coverage more affordable.

ACA enrollment isn’t yet complete, but 2024 is smashing previous records
ACA marketplace sign-ups during open enrollment, 2014-2024 to date
ACA chart

Experts say Medicaid redeterminations are also contributing to sign-ups, though regulators don’t yet have clear data on the extent of the trend. States resumed checking beneficiaries’ eligibility for the safety-net program last spring, and since then more than 14 million Americans have been booted off Medicaid.

The 20.4 million people that have enrolled during this open enrollment period represent a 25% jump from the 16.3 million sign-ups during 2023’s open enrollment season — also a record at the time.

Forty-five of the 50 states had their ACA enrollment increase compared to last year, according to KFF. Some red states saw particularly high growth this season, including West Virginia and Louisiana, which both saw enrollment jump about 63% year over year.

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