More than 1 million Georgians sign up for ACA health plans, a big record

Temporary subsidies have lowered premium costs for middle and higher income shoppers. Many patients are also losing Medicaid and looking for other options.

More than 1.2 million Georgians have signed up for health insurance plans on the Affordable Care Act marketplace, breaking all previous records and adding several hundred thousand to the state’s rolls of those with private insurance.

Georgia was part of a nationwide record-breaking increase in coverage, which brought the country’s ACA plan membership to 20 million, with several more days left to enroll. The main window for signing up for 2024 coverage closes Jan. 16.

The Affordable Care Act, also known as Obamacare, was former President Barack Obama’s signature health care law. It subsidizes premiums for people who can’t afford to buy health insurance on their own, but make too much to qualify for Medicaid.

This year, Georgia’s record sign-ups rose nearly 40% from last year, well over the nation’s average increase of 25%, said Krutika Amin, associate director of the Program on the ACA at the health research organization KFF. And the number of new sign-ups this year, an additional 350,000 over 2023, was the third biggest number in the country, behind only Texas and Florida.

In 2023, Georgia reported 879,000 new ACA enrollees.

Multiple factors are at play, Amin said.

Federal subsidies have made premiums free or nearly free for huge numbers of people who make below-average incomes. And under the Biden administration premiums have also been capped for upper-income people at no more than 8% of their income. That subsidy is set to expire in 2025.

In addition, Georgia and all states are in the process of disenrolling people from Medicaid who no longer qualify. Some of those people probably now qualify for an ACA plan.

Marketing and outreach has increased during the Biden administration after being cut during the Trump administration. The Biden administration has invested millions more dollars into hiring navigators who help people enroll.

Separately, Georgia Gov. Brian Kemp also is subsidizing ACA premiums statewide through a “reinsurance” program, and he has taken credit for enrollment increases. But while that helps put downward pressure on prices, Kemp’s subsidies are not likely the major factor reducing prices right now, Amin said.

Bill Custer spent years tracking the enrollment numbers in the turbulent early rollout of the exchange as a professor at Georgia State University. Politics and rocky implementation sent enrollment up and down and at times some Georgia counties were in danger of losing companies willing to operate there altogether.

“It is a big number,” Custer, now retired, said Wednesday of the 1.2 million new enrollees. “I think we’re getting towards percentages of coverage you would have expected in a perfect world, had enactment and implementation been smooth.”

Custer agreed with Amin on the likely causes. He said the most impactful are likely the subsidies that lowered the cost of plans.

In addition, it requires the insurance companies to offer plans that cover pre-existing conditions such as cancer, asthma, or diabetes. Before the ACA, people who were diagnosed with a medical condition and tried to buy health insurance would be told the insurance would not cover the cost to treat that condition.

President Biden trumpeted the results in a written press announcement Wednesday.

“The Affordable Care Act is more popular than ever, and Affordable Care Act coverage is more affordable than ever,” he said. “Thanks to efforts by my administration, millions of Americans are saving hundreds or thousands of dollars each year on health insurance premiums, and most people who shop for coverage at can find a plan for $10 a month or less.”

Former President Donald Trump recently renewed his calls to repeal the ACA.

“Obamacare is a catastrophe, nobody talks about it,” Trump said at a rally in Iowa on Saturday. The former president went on to criticize the late Republican Sen. John McCain of Arizona for blocking GOP efforts to scuttle the law more than five years ago.

Biden retorted in his written statement Wednesday that repealing the ACA would be “a catastrophe for families who would face skyrocketing health care costs.”

Although open enrollment for health insurance plans purchased through the Affordable Care Act ends on Jan. 16, people who have been removed from Medicaid may be eligible to enroll through the end of July.

The Associated Press contributed to this article.