ACA Enrollment Skyrocketed since 2020

April 04, 2025

Enrollment in Affordable Care Act (ACA) health insurance plans more than doubled in five years, according to new analysis.

The report from the Kaiser Family Foundation shows the ways enhanced subsidies supported enrollment during the pandemic and beyond.

Here’s what you need to know:

• By the numbers:  Open enrollment for 2025 reached 24.3 million plan selections, up from about 11.4 million during 2020.
• In Pennsylvania:  Pennsylvania's ACA enrollment has grown 50 percent from 331,825 during 2020 to 496,551 during 2025.
• Driving the trend:  Additional federal support to cover the costs of premiums strongly contributed to enrollment growth, the report indicates.
• Up and down:  Texas (255%), Mississippi (242%), West Virginia (234%), Louisiana (234%), Georgia (227%), and Tennessee (221%) saw the largest increases since 2020.
  • Other states—Oregon (-4%) and New York (-19%)—saw ACA declines due to expanded eligibility for their Basic Health Plans and Medicaid coverage.
• Up next:  These additional subsidies are set to expire at the end of the year and will require from action from Congress.
  • The cost to extend these enhanced subsidies would be $335 billion over 10 years, the report notes.

The report is available to review online.