The Biden-Harris administration announced Wednesday that 24 million people signed up for an Obamacare exchange plan during the 2025 open enrollment period, a record high as subsidies that expanded this health insurance coverage are poised to expire at the end of the calendar year.
“We have once again set a record when it comes to ensuring access to affordable, quality health care: nearly 24 million Americans have signed up for Affordable Care Act coverage,” President Joe Biden said in a statement Wednesday. “That means that enrollment has nearly doubled since I took office. That’s no coincidence.”
Approximately 3.2 million people enrolled for the first time in an Obamacare exchange insurance plan since the start of the 2025 open enrollment period in November 2024, while more than 20 million reenrolled in an exchange plan. Together, that is roughly double the 12 million people who signed up for Obamacare coverage for 2021, the last year of enrollment under the first term of President-elect Donald Trump.
According to White House estimates, 45 million people are covered under Obamacare, either through Marketplace plans or through Medicaid expansion policies.
Early into Biden’s term, Democrats expanded Obamacare as part of the 2021 American Rescue Plan, increasing premium tax credits for people already eligible for assistance, capping Obamacare insurance premiums, and increasing the income threshold for subsidy eligibility.
The Inflation Reduction Act, passed in 2022, kept premium assistance in place until 2025, making Obamacare plans more affordable for a larger portion of the population.
Whether to continue this subsidy expansion is poised to be a significant battle in Congress this year and a headache for the incoming Republican trifecta.
The Congressional Budget Office estimates that extending the subsidies could cost $335 billion over the next 10 years, but the Obamacare program has reached an all-time high in popularity.
Public opinion on Obamacare has steadily improved since 2016, but it has significantly increased following the implementation of the Biden-era premium subsidies, according to health policy think tank KFF. As of April 2024, 62% of people approve of Obamacare overall.
During the 2024 presidential campaign, Trump said that he had “concepts of a plan” to follow through on his 2016 promise to repeal and replace Obamacare, but he has not subsequently released substantive details of what he hopes to accomplish.
Later in the campaign, Trump said that he would administer the Obamacare program “as good as it can be run.”
In October 2024, House Speaker Mike Johnson (R-LA) promised that healthcare reform would be “a big part of the agenda” and there would be a “very aggressive first 100 days” of policy change following a Trump inauguration.
At the same time, Johnson told reporters that Obamacare is “so deeply ingrained” and that it would take “massive reform to make this work.”
Vice President-elect J.D. Vance, who has been critical of Republican efforts to entirely repeal Obamacare, came under fire during the presidential campaign when he argued that Trump “saved the very program from a Democrat administration that was collapsing and would have collapsed absent his leadership.”
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Biden urged his colleagues on Wednesday “to double down on the progress we have made and ensure Americans have access to quality, affordable health care by extending the [Affordable Care Act] premium tax credits this year.”
Democrats have attempted several times to extend the tax credits for another year, but the proposals did not pass muster before lawmakers went home for the holidays.