Obamacare Insurance: As open enrollment for the Affordable Care Act (ACA) kicks off, more Americans than ever are insured, with over 21 million people purchasing health plans through the ACA. This year, open enrollment on Healthcare.gov and state marketplaces, like Georgia Access and Covered California, began on November 1 and will run through January 15, 2025, in most states. For those seeking coverage by January 1, sign-up is required by December 15.
The ACA has seen surging enrollments recently, driven by more affordable premiums—many people pay $10 or less per month—and an expanded range of plan options. Cynthia Cox, director of KFF’s Affordable Care Act Program, views this as a turning point: “I think this is really reflecting a turnaround in the ACA marketplaces.”
New Access for DACA Recipients – A Long-Awaited Milestone
One of the most significant changes this year is the eligibility of Deferred Action for Childhood Arrivals (DACA) recipients, known as “Dreamers,” for ACA health plans. Until now, these individuals, who were brought to the U.S. as children and are legally authorized to work, were excluded from federal health insurance programs. Now, they join other Americans in having access to marketplace plans and the accompanying federal subsidies that make premiums more affordable.
Camila Bortolleto, a 36-year-old DACA recipient in Connecticut, shared how challenging it has been to manage health costs without insurance. Recently, she had to pay out-of-pocket for urgent care after a dog bite. For her and other Dreamers, this new access offers crucial peace of mind and financial relief. “It does give me a sense of safety that I will be able to get health insurance while I still look for the next job,” Bortolleto said.
ACA Marketplaces Now Include Year-Round Access for Low-Income Individuals
New for 2025, low-income Americans can now enroll in marketplace plans any time during the year, a shift from the traditional fall-only enrollment period. This change mirrors Medicaid’s year-round access, helping ensure that people facing economic challenges can find coverage when they need it. Insurance companies will also need to meet new limits on patient wait times for doctor appointments—a move aimed at reducing delays for those on plans with limited provider networks.
Challenges Ahead: The Election and Funding Uncertainty
Despite record enrollments, the future of ACA subsidies is uncertain. Federal subsidies that make marketplace plans so affordable are set to expire next year unless extended by Congress. Additionally, the results of the upcoming presidential election could reshape ACA policies. Vice President Kamala Harris has voiced her support for expanding the ACA, while former President Donald Trump, in recent statements, mentioned having “concepts of a plan” to replace it.
Legal Challenges Facing the ACA
The recent eligibility expansion for DACA recipients is also being challenged in court. In August, Kansas and 18 other states filed a lawsuit aiming to block this rule, citing concerns over potential “resource burdens” on taxpayers. Arthur Caplan, head of the Division of Medical Ethics at NYU Langone, criticized the suit, stating, “It makes sense to get people into health insurance… they’re going to show up to the ER if they get sick, and you’re going to pay for them at higher prices.”
For Dreamers like Dania Sarahi Quezada, a law student at the University of Washington who plans to sign up this year, this fight is personal. Quezada manages her health needs with limited clinic visits due to lack of insurance and worries about the lawsuit. “This is my home, and I am going to fight to be allowed to live here,” she said.
How to Enroll and Key Dates to Remember
For those looking to secure ACA health coverage, enrollment is open through January 15. To have coverage active on January 1, enroll by December 15. Seventeen states operate their own health insurance marketplaces, though all eligible Americans can start at HealthCare.gov for guidance.
This year’s ACA enrollment comes with expanded coverage and lower premiums, potentially bringing the U.S. closer to an all-time low in uninsured rates. The outcome of the 2024 election and related legal battles may ultimately decide the future of the ACA, but for now, millions of Americans have a chance at affordable coverage through the program’s growing reach
