WisCovered.com is operated by the Wisconsin Office of Insurance (OCI) to inform consumers seeking health insurance about their options, including BadgerCare and the Affordable Care Act's health insurance marketplace (Screenshot | WIsCovered.com)

People are getting health coverage under the Affordable Care Act (ACA) at a pace that approaches recent record-breaking years for the landmark federal health care law enacted 14 years ago.

In the first two weeks of November, when the annual open enrollment period to buy health insurance through the ACA’s platform Healthcare.gov began,  nearly half a million previously uninsured people in the U.S. signed up for coverage, according to the federal government. More than 2.5 million have renewed coverage that they purchased a year ago.

“We’re incredibly busy,” said Adam VanSpankeren, navigator program manager for Covering Wisconsin, a nonprofit that helps people looking for insurance. “There’s a lot of anxiety and people have concerns about the future of the ACA, but it’s not stopping them from getting coverage.”

Covering Wisconsin is federally funded and subcontracts with 44 navigator agencies across the state  — part of a program established under the ACA to guide people in assessing their options and choosing an appropriate health plan.

“Health insurance is really complicated,” VanSpankeren said in an interview. Navigators were included in the law to provide “people on the ground to explain to people how this works and how you sign up.”

To help spread awareness of coverage under the ACA, the Wisconsin Office of the Commissioner of Insurance (OCI) has been distributing information to community agencies, including local libraries and county health departments.

“Ensuring that everyone has access to high quality and affordable insurance on Healthcare.gov has been a priority of our office,” said OCI communications director Susan Smith. “Last year’s open enrollment period was the highest ever in Wisconsin, with over 254,000 people getting coverage.”

The open enrollment period to purchase health insurance for 2025 through the marketplace began Nov. 1. Through Nov. 16, according to the Centers for Medicare & Medicaid Services (CMS), 48,564 Wisconsin residents signed up.

While that’s lower than the same period a year ago, when nearly 59,000 people had enrolled, VanSpankeren doesn’t find that difference significant this early in the enrollment period.

People who enrolled last year are automatically renewed if they don’t change plans, and their enrollment numbers aren’t listed yet, he said. The full open enrollment period ends Jan. 15, 2025. For coverage starting Jan. 1, 2025, the deadline to enroll is Dec. 15.

Expanding health coverage

Enacted in 2010 and fully implemented four years later, the ACA instituted new standards for health insurance plans, including barring insurers from denying health insurance coverage or increasing premiums for people due to pre-existing health conditions.

The law required insurers to cover young people up to age 26 under their parents’ health plans, and required coverage for preventive care such as vaccines.

It also expanded the federal Medicaid program to cover families with incomes up to 138% of the federal poverty guideline. Under a U.S. Supreme Court ruling in 2012, Medicaid expansion was made optional, with states deciding whether or not to take part. Wisconsin is one of 10 states that has not done so. 

Healthcare.gov, the health insurance marketplace, was a central element of the ACA, because uninsured Americans are mainly people who don’t get coverage from an employer or through programs such as Medicaid.

“Most people get insurance from their jobs, but there are still millions and millions of people who don’t,” VanSpankeren said. Those include self-employed people and people with multiple part-time jobs and no health coverage. They also include people whose employers don’t offer insurance or offer plans that require employees to pay more than they can afford for coverage.

Under the ACA, plans sold directly to individuals and families must cover a list of essential health benefits. The federal health care marketplace requires insurers who participate to offer plans meeting the federal standards.

Having a government marketplace that sets minimum standards protects consumers, VanSpankeren said.

“There’s a lot of bad actors with bad products” — insurance plans that don’t meet the ACA’s standards, he said. Without Healthcare.gov to vet participating plans, “you have kind of a Wild West scenario.”

Outside the marketplace, unscrupulous operators, often from out of state, misrepresent the plans they sell, sometimes even switching people’s coverage without their knowledge, said Smith of OCI. OCI and insurance regulators from other states are working with CMS to address what “is still a national challenge,” she said.

Safe in 2025; after that, uncertainty

VanSpankeren said people enrolling this year are asking Covering Wisconsin navigators about what they’ll have to pay in the new year. The recent election is also on the mind of many.

“They want to know if a change in administration means anything for their plan,” VanSpankeren said. Current provisions in the law remain in effect through 2025, so “we can reassure people everything they’re doing today for the next year is good.”

Those provisions include enhanced tax-credit subsidies based on a person’s income that lower the cost of their health insurance premiums purchased on the marketplace. Those increased subsidies were first introduced in 2021 and extended in 2022 through the end of 2025.

Beyond next year, however,  ACA advocates are worried about their future.

Republicans, who will hold majorities in both houses of Congress starting in January, and President-elect Donald Trump have been openly hostile to the health law and tried repeatedly in Trump’s first term to end it without success.

On Friday, Protect Our Care, a national campaign to support and strengthen the ACA, highlighted a series of analyses looking at the impact of ending the subsidies after 2025. Protect Our Care also cited the ambition of Congressional Republicans to block their renewal.

KFF, a nonprofit health policy research, polling, and news organization, reported in a study in July that 92% of people covered under the ACA were subsidy recipients.

In a study published Nov. 14, the Center on Budget and Policy Priorities called for Congress to act by the spring of 2025 to give insurers time to set their rates for open enrollment a year from now.

“If Congress allows the improved tax credits to expire, nearly all marketplace enrollees, in every state, will face significantly higher premium costs,” the center stated.

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