Michigan sees highest Obamacare enrollment since 2016

State and federal officials announced Thursday that 322,273 Michigan residents signed up for 2023 insurance on the marketplace during the recently concluded open enrollment period. That was up 6% from a year earlier, and according to federal data, marks the highest "Obamacare" enrollment in Michigan since 2016 when 345,813 residents signed up. The insurance is known as Obamacare because it came into being when Barack Obama was president.

Nationwide, a record 16.3 million people enrolled in an insurance plan for this year through the ACA marketplace.

The sign-up numbers were boosted by an extension of extra tax credit subsidies for ACA plans that first started with the March 2021 passage of the 1.9 trillion American Rescue Plan. Those subsidies were set to expire at the end of 2022, but were extended for three additional years through 2025 when President Joe Biden in August signed the Inflation Reduction Act.

Prior to the extra subsidies, ACA enrollees with incomes over 400% of the federal poverty line ($54,360 for individuals, $111,0000 for a family of four) were ineligible for any subsidy. Now those households qualify for some level of subsidy and don't have to contribute more than 8.5% of their income when buying a "benchmark" Silver plan sold on the Healthcare.gov marketplace.

The annual cost to the federal government of the extra subsidies was projected at about $22 billion.

Anita Fox, director of the Michigan Department of Insurance and Financial Services, said the growing enrollment is good news. ACA sign-ups had been trending down until last year, when the extra subsidies first debuted for open enrollment.

With the expanded subsidies, some households qualify for ACA premiums as little as $10 a month, she said.

"This is a major win for the health of this state," Fox said. "Reversing the downwards trend has had its challenges, because we know that many people think that getting covered is too difficult or too expensive, and that leads people to going without health insurance, leaving them at risk for poor health outcomes and steep medical bills."

The uninsured rate in Michigan is about 5%, according to data compiled last year by the Center for Health and Research Transformation at the University of Michigan.

In 2013, the last year before the start of ACA coverage and Michigan's expansion to Medicaid eligibility, Michigan had a 11% uninsured rate.

Nationwide, the uninsured rate was 8% in 2022.

The Biden administration has lengthened the open enrollment period on Healthcare.gov from Nov. 1 through Jan. 15 after the Trump administration shortened it. This year, Michiganders could chose plans on the marketplace from 10 different insurance companies.

Outside of the ACA's open enrollment period, people generally cannot sign up for a marketplace plan unless they experience a qualifying major life change. Those changes include moving, getting married, losing employer-sponsored health insurance when leaving a job and having or adopting a child.

The Inflation Reduction Act also capped the price of insulin copays for Medicare recipients with diabetes at $35 per month starting Jan. 1.

If that cap had been in place in 2020, a recent federal report found that it would have saved Michigan seniors an average of $403 per year, said Joseph Palm, a regional director for U.S. Department of Health & Human Services.

Affordable Care Act marketplace enrollment in Michigan

2023: 322,273

2022: 303,550

2021: 267,070

2020: 262,919

2019: 274,058

2018: 293,940

2017: 321,451

2016: 345,813

2015: 341,183

Source: Centers for Medicare & Medicaid Services data