This story has been updated with additional information from the Oregon Health Authority.
The number of Oregonians enrolling with a federally subsidized health insurance marketplace barely ticked up upwards this year, despite a record number of people nationally using the program for coverage.
State officials, however, say that shows Oregon’s past efforts to keep people covered are bearing fruit.
Federal officials announced Wednesday that 21.3 million people signed up to buy coverage through online marketplaces during the 2024 open enrollment period. That’s roughly 5 million more than the previous year, a 30% increase, and the third year in a row of record enrollments nationally.
Fueling the continued surge in overall Affordable Care Act enrollments are hefty increases in federal marketplace subsidies that began during the pandemic. Not only that, but states have resumed eligibility checks of their Medicaid rolls after a pandemic-era pause, pushing people to marketplaces according to health care policy think tank KFF.
The online marketplaces were launched in 2014 under the Affordable Care Act. In Oregon, 145,509 consumers used Oregon’s website to sign up for coverage during the open enrollment period that ran between Nov. 1 and Jan. 16. That’s a 2% increase from the previous year.
Only a handful of states, including New Jersey, Alaska, Hawaii and Nevada, saw single digit percentage increases. The District of Columbia and Maine saw 3% drops and California remained flat.
Oregon Health Authority spokesperson Erica Heartquist told The Lund Report that the small increase is still a “win” because it meant more Oregonians are covered.
“While we’re still analyzing the most recent data, it’s important to note that at the start of this open enrollment period, approximately 96% of Oregonians already had health insurance coverage,” she wrote. “This means that only 4% of Oregonians were uninsured, lower than the national uninsured rate of 7.7%, which could’ve contributed to the trends we saw during this open enrollment period.”
Oregon’s enrollment using the marketplace has been “basically flat for five years straight,” Charles Gaba, a long-time health enrollment tracker who runs the blog ACAsignups.net, told The Lund Report in an email.
Last year, enrollment went down, and the previous year saw only a slight gain. In fact, Oregon enrollment in the marketplace peaked in 2018 when 156,105 picked plans through the marketplace. Marketplace figures don’t include Oregonians who bypass the subsidized enrollment website and use agents or sign up directly with insurers — a group that numbered more than 30,000 last year.
While 2024 was the third straight year of below-average marketplace enrollment gains for Oregon compared to other states, that’s in part because other states expanded their Medicaid programs later than Oregon did to take advantage of increased funding under the Affordable Care Act.
There are three other reasons that may help explain Oregon’s low enrollment gains, according to Heartquist.
Eligibility checks: The health authority last spring resumed routine checks to see if members of the Medicaid-funded Oregon Health Plan made too much to stay on the low-income health plan.
Officials have prioritized helping low-income Oregonians keep their coverage during the process and used a phased approach designed to keep people on the plan as long as possible and postpone decisions on the most vulnerable cases.
So far, it’s paid off. Heartquist said that as states resumed Medicaid eligibility checks, Oregon has had the second lowest termination rate at 13.7%, behind Maine.
By contrast, Republican-led states that didn’t prioritize keeping people’s Medicaid coverage saw the most new Affordable Care Act enrollments in 2024, with Texas, Florida and Georgia accounting for half, according to KFF.
About 15% of people who enrolled in a plan using the federal marketplace, HealthCare.gov, were previously enrolled in Medicaid, according to the U.S. Department of Health and Human Services.
Expanded Medicaid eligibility: In 2022, lawmakers approved a process that led to the state applying for federal permission to establish a Basic Health Program, intended to expand Medicaid-style free health care to the working poor, making between 138 to 200% of the federal poverty level ($62,400 for a family of four).
The program goes into effect in July, but until then the the health authority successfully sought permission from the federal government to allow people in that income range stay on the Oregon Health Plan until July.
The health authority estimates that 55,000 people are keeping their Oregon Health Plan coverage due to the extension, meaning they aren’t being forced to the marketplace to seek coverage that would be more expensive and less generous.
Better-than-average coverage rates: Heartquist also cites Oregon’s historically high insurance rate, saying that has meant the state had less room to grow.
“While we’re still analyzing the most recent data, it’s important to note that at the start of this open enrollment period, approximately 96% of Oregonians already had health insurance coverage. This means that only 4% of Oregonians were uninsured, lower than the national uninsured rate of 7.7%, which could’ve contributed to the trends we saw this open enrollment period.”
Gains may not last
Federal officials say the expanded subsidies approved during the pandemic and extended in the Inflation Reduction Act have helped drive the coverage gains nationally, making coverage through the marketplaces more affordable. Four out of five people who used HealthCare.gov, the federally run marketplace, found coverage for $10 or less per month because of the subsidies.
Those subsidies extend through 2025 — after which premiums in the individual market are projected to surge. Meanwhile, in Oregon, state projections estimate that as a result of the Basic Health Program, premiums for some people making more than 200% of the federal poverty level could jump significantly, sparking protests from insurers that the change could destabilize the state marketplace.
The health authority projects that approximately 153,000 Oregonians will be enrolled in an Affordable Care Act plan in 2025.