The Biden-Harris administration has announced a historic milestone: nearly 24 million American (including approximately 64,000 District resident) have signed up for Affordable Care Act (ACA) Marketplace coverage for 2025, with one week remaining in the open enrollment period. The record-breaking figure represents nearly doubling enrollment since President Joe Biden took office. Over 45 million Americans are covered through the ACA’s Marketplace and Medicaid expansion, marking an all-time high in health insurance coverage in U.S. history.
Biden hailed the achievement as a direct result of his administration’s efforts to make health care more affordable and accessible. “When I took office, I made a promise to the American people that I would bring down the cost of health care and prescription drugs, make signing up for coverage easier, and strengthen the Affordable Care Act, Medicare, and Medicaid,” Biden stated. “I’m proud that my administration delivered—even as Republican elected officials stood in the way. I urge Congress to double down on the progress we have made by extending the ACA premium tax credit this year.”
Over the past four years, the administration implemented initiatives contributing to record-breaking enrollment and reduced healthcare costs. Key measures included enhancing ACA premium tax credits, which saved consumers an average of $800 annually on premiums, and simplifying enrollment processes, particularly for underserved and rural communities. Medicaid expansion in four additional states provided coverage for over one million people while eliminating bureaucratic barriers ensured millions could apply for or renew coverage seamlessly.
The administration also took aggressive steps to lower prescription drug costs, with the Medicare Drug Price Negotiation program achieving prices 38% to 79% lower than U.S. list prices for the first 10 negotiated drugs. Medicare beneficiaries benefited from a $2,000 annual cap on out-of-pocket costs and a $35 monthly cap on insulin. The White House said those initiatives put billions of dollars back into the pockets of seniors and individuals with disabilities.
Despite these successes, the ACA faces an uncertain future. President-elect Donald Trump and Republican lawmakers, who will control the House and Senate, have expressed intentions to overhaul the law. During his campaign, Trump criticized the ACA as overly expensive and suggested retooling or repealing key provisions. Republican leaders have signaled plans to prioritize changes, which could result in significant premium increases and coverage losses.
Officials noted that enhanced premium tax credits are set to expire without Congressional action. If that happens, premiums could skyrocket. For example, a single parent earning $50,000 annually could see their premiums increase by $1,600, while a retired couple earning $85,000 could face an $18,000 increase. Experts estimate that between three and five million Americans could lose health insurance entirely.
The White House noted that the ACA’s impact extends beyond Marketplace coverage. Today, Medicaid covers approximately 80 million Americans, with the administration driving initiatives to simplify enrollment and expand postpartum coverage for hundreds of thousands of new mothers. Other healthcare advancements under the Biden-Harris Administration include a 17% reduction in overdose deaths in the 12 months ending July 2024 (the largest decline in U.S. history) and a significant decrease in new HIV infections following the launch of a national strategy to end the epidemic by 2030.
Administration officials said Biden and Harris’s comprehensive efforts to improve healthcare access, affordability, and equity have also addressed mental health and maternal health crises. The 988 mental health lifeline, created under Biden’s leadership, has answered over 11 million calls, chats, and texts that have provided immediate support to individuals in crisis. Additionally, 46 states and the District of Columbia extended Medicaid postpartum coverage from two months to 12 months.
While Biden praised the progress made during his presidency, he warned of the risks ahead. “If Republicans in Congress take away the enhanced premium tax credits, premiums will skyrocket, and millions of Americans could lose coverage,” he said. “We cannot afford to let this progress slip away.”
