Graphic via Desirée Tapia
Graphic via Desirée Tapia

After declining enrollment during the Trump administration, a record number of people sign up for coverage.

Health insurance enrollment through the Affordable Care Act (ACA)—discouraged, downplayed, and obstructed by the administration of former President Donald Trump—rebounded sharply in President Joe Biden’s first year in office, setting a new record for coverage nationwide as more than 200,000 people in Wisconsin obtained the extra security.

The most recent open enrollment period to obtain coverage through the ACA marketplace ended Jan. 15, and yet-to-be finalized figures from the US Department of Health and Human Services show more than 14.2 million Americans signed up for a plan, including 205,991 in Wisconsin, a 7.2% increase over the past year.

“ACA enrollment declined under Trump, but the program hardly collapsed,” Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told CNBC. “The ACA defied every effort by the Trump administration to kill it—the Trump administration and Congress.”  

The ACA was designed to provide financial assistance so more Americans could afford coverage from private health insurance companies who participate in the program. While Trump undercut the ACA by shortening enrollment periods, and a Republican-led Congress unsuccessfully tried to kill the program also known as Obamacare, the Biden administration opened new enrollment opportunities and extended them when the coronavirus pandemic began.

ACA premiums were made more affordable last year by a provision in Biden’s American Rescue Plan pandemic relief bill, which passed Congress without any Republican votes. The plan extended ACA eligibility to 1.4 million Americans, but that temporary eligibility expires at the end of 2022 unless Congress passes a provision like one found in Biden’s Build Back Better economic agenda that remains blocked by two Democratic and all 50 Republican senators.

Efforts to impede healthcare coverage continue in Madison, as Wisconsin remains one of only 12 states to not expand Medicaid coverage, known here as BadgerCare, to people making up to 138% of the federal poverty line, or $17,774 per year. 

That provision of the ACA has been blocked for a decade while Republicans control the Assembly and state Senate, preventing an estimated 91,000 people in Wisconsin in lower-income households from coverage and costing state taxpayers $1.6 billion in lost federal aid during the current 2021-23 state budget period. Expanding Medicaid is extremely popular, with 70% support in Wisconsin polls.

Related: Does Wisconsin Have a BadgerCare Coverage Gap? Ask Robin Vos’ Employee.

Most recently, legislative Republicans have introduced new bills to limit assistance to lower income and unemployed Wisconsinites. One bill states that a worker whose income is low enough to qualify for BadgerCare coverage cannot decline an employer’s request for more hours or higher wages in order to remain on BadgerCare. The proposal could push some workers into a coverage gap because of the Legislature’s refusal to expand BadgerCare eligibility to people just above the poverty line.

“People want to work, but when a 25-cent raise could result in losing access to critical medical care, it puts working families in an impossible position,” said Sen. LaTonya Johnson (D-Milwaukee) in a Wisconsin Examiner report. “Families deserve a clear, gradual pathway off of assistance programs—not to be thrown headfirst off a cliff into poverty.”

The vast majority of new ACA coverage plans were selected by people living in the states where Republicans have blocked Medicaid expansion. Members of Congress, including Sen. Tammy Baldwin (D-Wisconsin), have proposed a workaround that creates a special Medicaid program for those states, either as a standalone bill or as part of Biden’s Build Back Better proposal.

Levitt is among those who believe the growth in ACA enrollment and Medicaid are proof of the permanence of the once politically fragile efforts to provide more healthcare security for Americans than what they saw when for-profit companies’ restrictions dominated the marketplace.

“I think the more people who depend on the ACA, the more people are focused on health care as a result of the pandemic … makes it even harder to consider repealing [Obamacare],” Levitt said. “I think Republicans were burned by their effort to repeal the ACA. I think many of them don’t have a taste for retrying.”