By: Suzanne Wikle 

In 2024, a record 21.4 million people received their health insurance through the Affordable Care Act (ACA) Marketplaces. Enrollment gains among Black, Latino, and people with low incomes drove the increased enrollment. Sustaining the policy choices that led to record enrollment and adding in long overdue eligibility for people with Deferred Action for Childhood Arrivals (DACA) status will be important to keep up the momentum and keep affordable health insurance available. With these policies in place, 2025 is poised to be another record-breaking year for Marketplace enrollment.  

Several policies have led to this historic enrollment, but the gains are not guaranteed to stay, unless Congress acts.  

Enhanced Premium Tax Credits
People receive premium tax credits to purchase health insurance through the ACA Marketplaces when they do not have other affordable options. The premium tax credits lower the amount people pay every month for their premiums. Starting in 2021 the tax credits were enhanced, making Marketplace plans much more affordable. People earning less than 150 percent of the federal poverty level can be insured for $0 monthly premium; for those who had out-of-pocket costs, their premiums were reduced an average of 44 percent.  

Since the enhanced tax credits became available, 83 percent of the growth in Marketplace enrollment has been by people with incomes less than 250 percent of the federal poverty level. Black and Hispanic enrollment increased the most. Compared to 2020 (non-enhanced tax credits), enrollment in 2023 (with enhanced tax credits) increased by 95 percent among Black enrollees and 103 percent among Latino enrollees. Enrollment among American Indians and Alaskan Natives grew by 59 percent;, multiracial enrollment grew by 28 percent;, white enrollment grew by 25 percent;, and Asian-American, Native Hawaiian, and Pacific Islander enrollment grew by 14 percent. 

What’s at stake: The enhanced tax credits for Marketplace enrollments are slated to end on December 31, 2025. Congress must act to extend or make permanent the enhanced tax credits that have led to record enrollment, particularly among people with low incomes and people of color. Without Congressional action, we can expect to see fewer people enrolling in Marketplace coverage, greater out-of-pocket costs for those who do enroll, and an increase in the number of people without health insurance. An individual making $21,000 per year would have to pay nearly $800 more in annual premiums, and a family of four making $60,000 would see an annual premium increase of $2,700.  

DACA Eligibility for ACA Marketplace Tax Credits 

 When the annual open enrollment period begins on November 1, 2024, an exciting and long overdue new policy will take effect. People with DACA will be newly eligible to buy health insurance and receive tax credits through the Marketplace. The Congressional Budget Office estimates that around 100,000 people with DACA will enroll for 2025 coverage. The new policy also clarifies that other vulnerable youth, such as those who have been approved for Special Immigrant Juvenile status and those applying for asylum, will also be eligible for coverage.  

What’s at stake: DACA eligibility for Marketplace coverage is being challenged by some states. Oral arguments were held on October 15, 2024, but at the time of publication, people with DACA will still be able to enroll in Marketplace coverage and receive tax credits when open enrollment begins on November 1, 2024. 

The progress made connecting people with affordable health insurance options is the direct result of important policy changes. In order to continue the progress and not lose ground – especially for Black people, Latinos,  DACA recipients, and immigrant youth – we must ensure the right policies stay in place. Congress must act to continue enhanced premium tax credits beyond 2025 and ensure DACA recipients and immigrant youth continue to have access to affordable health care.