President Biden is boasting that the uninsured rate is at a record low, taking credit for growth in individual market enrollment and setting up a 2024 election issue, particularly as an expiration of massive health-insurance subsidies will confront whoever is president in 2025. In fact, recent expansions of Affordable Care Act (ACA) subsidies have driven exchange enrollment to record highs. But by itself, this is not evidence of the success of the ACA. Our new actuarial analysis, released this week by Paragon Health Institute, serves as a reality check. The truth is that the ACA has attracted half as many people at three times the projected taxpayer cost per new enrollee as expected before the law’s provisions took effect.
In 2013, the Congressional Budget Office projected that by 2021, 40 million Americans would enroll in the individual market, where most non-elderly middle-income people without an employer plan obtain health insurance. It turns out that there were only 20 million people enrolled. We estimate the ACA led to only 1.6 million more Americans with private health insurance despite $60 billion in annual subsidies to obtain these gains.
