A record 24 million people now get Obamacare health plans. Will it last under Trump?

Nearly 24 million Americans are buying their health insurance through the Affordable Care Act — and there's still a week to go for open enrollment sign-ups.

"We've once again set a new all-time record for marketplace enrollment," Neera Tanden, domestic policy adviser to President Joe Biden, said on a press call Tuesday. "In fact, every year of the Biden-Harris administration, we've set a new all-time record for ACA marketplace enrollment."

That 24 million is about double the number of people enrolled when President Biden took office four years ago, Tanden noted. After years of turmoil for the Affordable Care Act during the first Trump administration, Biden reversed course with new investments in the marketplaces, and enrollment numbers have shot up.

"Today, more than 300 million Americans have health coverage — that's a record number," Health Secretary Xavier Becerra told reporters on the same press call. According to the latest report from the U.S. Census, 92 percent of Americans have health insurance.

Enrollment is still open until Jan. 15 (in all states except Idaho) for coverage that starts Feb. 1.

Most Americans get their insurance through their jobs or through a public program like Medicaid or Medicare, but ACA health insurance still has a big impact on the overall percentage of people insured. As enrollment in the marketplaces set records in the last few years, the number of uninsured Americans dropped dramatically.

This may well be the high watermark for enrollment in these health plans. When President-elect Trump takes office, he could again undermine the law as he did in his first term by not funding it fully. Although "repealing and replacing," the ACA wasn't one of Trump's campaign pledges, he did say during a debate that he had the "concepts of a plan" to replace the 14-year-old health law.

Senior Biden administration officials who also spoke on the press call say policy changes — including extra federal subsidies that have made premiums much more affordable, streamlined sign-up processes, and a big investment in advertising and one-on-one enrollment helpers — caused the surge in enrollment.

This year, for many people, premiums are $10 or less per month, and there are a variety of plan options to choose from.

The extra federal subsidies will expire at the end of 2025, unless congressional lawmakers vote to extend them or make them permanent. Republicans won the majority in both houses of Congress and haven't historically supported the Affordable Care Act, let alone Biden's COVID-19-era law that created the extra subsidies.

The Republican Study Committee's 2025 fiscal budget says the subsidies "only perpetuate a never-ending cycle of rising premiums and federal bailouts — with taxpayers forced to foot the bill."

The incoming chair of the Senate's HELP committee, Sen. Bill Cassidy, R-La., last year urged Congress to reject an extension, saying they "hide the unsustainable skyrocketing cost of Obamacare." Still, the number of newly insured people is especially high in Republican-led states. At least one Republican lawmaker, Sen. Lisa Murkowski of Alaska, recently told the Northern Journal that she would support extending the subsidies.

If lawmakers let those subsidies expire, "the results would be catastrophic," Tanden said. "A retired couple could see their premiums increase by $18,000 per year, and experts estimate that 3-5 million people would become uninsured."

With enrollment open for about another week, Tanden said she expects the final enrollment numbers will be even higher.

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