PLANNING AND EVALUATION HEALTH POLICY March 23, 2023

(@ ASPE |pnc.o ISSUE BRIEF
Health Coverage Under the Affordable Care Act:

Current Enrollment Trends and State Estimates

Based on 2022 and early 2023 enrollment data, more than 40 million people are
currently enrolled in Marketplace or Medicaid expansion coverage related to
provisions of the Affordable Care Act (ACA), the highest total on record.

 

KEY POINTS

e Marketplaces and Medicaid expansion, programs created by the Affordable Care Act (ACA), have
enrolled millions of Americans in participating states since their implementation in 2014.

e Nearly 15.6 million" consumers were enrolled in Marketplace plans as of February 2023 (across all
50 states and the District of Columbia), and 18.8 million people (across 38 participating states and
the District of Columbia) were newly enrolled in Medicaid via the ACA's expansion of eligibility to
adults as of September 2022.

e 1.2 million individuals were enrolled in early 2023 in the ACA's Basic Health Program option, and
4.6 million previously eligible adults gained coverage under the Medicaid expansion by September
2022 due to enhanced outreach, streamlined applications, and increased federal funding under
the ACA.

e Across these coverage groups, a total of 40.2 million Americans were enrolled in coverage related
to the ACA based on 2022 and early 2023 enrollment data, the highest total on record. This
represents 9.3 million more people enrolled than in 2021 (a 30% increase) and 27.6 million more
people enrolled than in 2014 (a 219% increase, or more than triple).

e This brief updates our estimate released In April of 2022 where we found more than 35 million
people had gained coverage under the ACA. Our current estimate of 40.2 million represents more
than 4 million people gaining coverage over the past year.

e Survey results indicate that all SO states and the District of Columbia have experienced substantial
reductions in the uninsured rate since 2013, the last year before implementation of the ACA.

 

 

* A total of 16.4 million consumers made plan selections as of January 2023 and an estimated 15.6 million consumers effectuated
enrollment (paid a premium or otherwise completed enrollment). See notes for Table 1 for more information.

 

March 2023 ISSUE BRIEF 1
BACKGROUND

The Affordable Care Act! (ACA), passed in 2010, brought the largest expansion of coverage in the U.S. health
care system since the creation of Medicare and Medicaid in 1965. A comprehensive health care reform law,
the ACA expanded health insurance coverage to millions of Americans through two main pathways:

* Providing premium tax credits to consumers with incomes between 100% and 400% of the federal
poverty level (FPL) to lower the cost of individual market health insurance purchased through new state
Marketplaces;' and

* Expanding Medicaid eligibility to adults with incomes up to 138% Federal Poverty Level (FPL), in
participating states (after the Supreme Court made the expansion a state option in a 2012 ruling).*

The ACA also invested in outreach and marketing to help eligible individuals enroll in coverage and streamlined
the application process for Medicaid, and the Biden-Harris Administration made strengthening Medicaid, the
Marketplaces, and the ACA a key priority. Since implementation of the ACA, the number of uninsured
Americans has fallen significantly. Between 2013 and 2021 the number of people without health insurance
dropped by 38 percent, falling from 45.2 million to 28.2 million."

This Issue Brief presents current estimates of enrollment in health insurance coverage obtained through the
ACA Marketplaces and the Medicaid expansion and the subsequent reductions in state-level uninsured rates
since the ACA was implemented in 2014. This brief updates our estimate released in April of 2022 where we
found that about 35 million people gained coverage under the ACA.

METHODS

For both Marketplace and Medicaid expansion enrollment, we present the most recent administrative data
with state-by-state totals from the Centers for Medicare & Medicaid Services (CMS), as well as historical
national totals for the years 2014-2023.

There are two related measures of Marketplace enrollment. The first is plan selections, and the second is
effectuated enrollment. At the end of open enrollment periods, CMS releases plan selections, which are the
number of people who have selected a plan; CMS follows later with data on effectuated enrollment, which
captures the number of people who have paid their first month's premium (if applicable). In this report,
Marketplace enrollment estimates reflect effectuated enrollment counts from both States with Marketplaces
using the HealthCare.gov platform and those with State-based Marketplaces. Effectuated enrollment for 2023
is not yet available but was estimated from state February 2022 effectuated rates applied to the number of
people selecting Marketplace plans during the 2023 Open Enrollment Period. This brief uses effectuated
enrollment so that our overall coverage estimates can be compared over time using the same method as ASPE
used in previous estimates of ACA-related coverage.?

Medicaid enrollment estimates are state-reported counts of unduplicated individuals enrolled in the state's
Medicaid program through the Medicaid Budget and Expenditure System (MBES). The most recent Medicaid

 

*Individuals with incomes above 400% FPL can purchase coverage through the Marketplaces but did not originally qualify for premium
tax credit subsidies. Under the American Rescue Plan and extended by the Inflation Reduction Act, individuals with incomes above
400% FPL are now potentially eligible for subsidies.

*The ACA established a Medicaid eligibility level of 133% FPL for children, pregnant women, and adults as of January

2014, and included a standard income disregard of five percentage points of the federal poverty level, which effectively

raises this limit to 138% FPL Medicaid. ACA Medicaid expansion to adults with incomes up to 133% FPL is a state option,

and as of February 2023, 39 states and the District of Columbia had adopted Medicaid expansion.

 

March 2023 ISSUE BRIEF 2
enrollment data are from September 2022. For states that have expanded Medicaid, the enrollment data
provide specific counts of the number of individuals enrolled in the new expansion adult eligibility group,
referred to as the "adult group," with separate totals for those who became newly eligible under the ACA
expansion, as well as those who would have been eligible for coverage prior to the ACA but are now part of the
adult group. State Medicaid expenditure reports are generally submitted to CMS within 30 days following the
end of each quarter. Some states, however, submit their expenditure reports later; accordingly, these results
should be considered preliminary.

Minnesota and New York have also implemented the Basic Health Program (BHP) option under the ACA to
cover individuals with incomes between 138-200% FPL. We report annual average BHP enrollment, as reported
to CMS by the states.

Note that we refer to the estimates below as "2023 estimates" of ACA coverage, though some of the statistics
are from late 2022, since those are the most recently available numbers.

Estimates on uninsured rates by state come from the American Community Survey (ACS), the largest national
survey of households. The Census Bureau surveys almost 300,000 households each month for the ACS and
collects health insurance and demographic data, along with other types of information. Uninsured rates for the
full state population of all ages come from the ACS's public data tables for 2013 and 2021 (the most current
year of ACS data available), which we used to compare state-by-state changes in uninsured rates since the
implementation of the ACA.*°

FINDINGS

National ACA-related enrollment for 2014-2023 are presented in Table 1 and Figure 1. More detailed
information on each source of coverage is described below.

As of February 2023, an estimated 15.6 million consumers had enrolled and effectuated health insurance
coverage through the Marketplaces. An estimated 18.8 million newly-eligible adults were enrolled in Medicaid
coverage through the adult group created by the ACA expansion based on the most recently available data, as
shown in Table 1. An additional estimated 4.6 million people were enrolled in the Medicaid expansion adult
group under the ACA who would have been eligible for Medicaid before the ACA. The ACA simplified Medicaid
enrollment for these individuals and made permanent under federal law some state-specific coverage
expansions that pre-dated the ACA (e.g., coverage under a section 1115 demonstration project). To date, 39
states and the District of Columbia have adopted the ACA Medicaid expansion of coverage to adults; South
Dakota has not yet begun enrolling individuals in its expansion, and other states including North Carolina are
considering proposals to expand but have not yet finalized them.

Medicaid and CHIP enrollment increased by 21.1 million enrollees from February 2020 to November 2022, or
an increase of 30 percent; most of this coverage increase occurred in Medicaid.® Medicaid enrollment
increased under the continuous enrollment provision in the Families First Coronavirus Response Act of 2020
(FFCRA), which prevented states from disenrolling most Medicaid enrollees during the COVID-19 public health
emergency (PHE) as a condition for receiving a temporary 6.2 percentage point increase in the federal
Medicaid match rate.' This, along with recent Medicaid expansions in states including Maine, Virginia, Idaho,
Utah, Nebraska, Utah, and Missouri, contributed to more individuals gaining coverage during the PHE.

Two states - Minnesota and New York - have implemented the Basic Health Program (BHP) option under the
ACA, with enrollment totaling approximately 1.2 million in early 2023.

 

March 2023 ISSUE BRIEF 3
Taken together, these results indicate that overall enrollment in Marketplace coverage, Medicaid expansion,
and the Basic Health Program for 2023 was approximately 40.2 million people, the highest enrollment total
since the ACA was enacted. This represents 9.3 million more people enrolled than in 2021 (a 30% increase)
and 27.6 million more people enrolled than in 2014 (a 219% increase, or more than triple). Since 2022, 4.2
million more people gained ACA-related coverage, with most of the coverage gains approximately evenly split
between Marketplace and Medicaid expansion gains.

Table 1
ACA-Related Enrollment: Marketplace, Medicaid, and the Basic Health Program (BHP), 2014-2023

 

 

 

 

 

 

 

 

 

 

Marketplace Medicaid Expansion Medicaid Expansion ald TOTAL
Enrollment* Group, Group, ieee ACA-Related
Newly-Eligible# CLM ales ice) lays
2014 6,337,860 4,214,218 2,047,055 0 12,599,133
2015 10,187,197 9,103,944 3,002,271 358,000 22,651,412
2016 11,115,044 11,135,415 3,473,065 654,000 26,377,524
2017 10,330,759 12,229,576 3,524,856 772,000 26,857,191
2018 10,643,786 12,338,135 3,305,210 798,000 27,085,131
2019 10,579,744 12,201,118 3,247,188 833,000 26,861,050
2020 10,673,516 12,300,921 3,241,535 866,000 27,081,972
2021 11,227,111 14,849,998 3,890,934 961,000 30,929,043
2022 13,807,669 16,781,800 4,261,277 1,135,190 35,985,936
2023 15,567,000** 18,765,611 4,648,343 1,239,503 40,220,457

 

 

 

 

 

 

 

 

Notes:

* Marketplace effectuated enrollment figures for 2014 and 2015 are as of 12/31/2014 and 3/31/2015 respectively, versus February

coverage as of 3/15 for 2016-2021. Marketplace enrollment data for 2014-2015 are lower quality due to the manual payment

processing system in place for those years. 2014 and 2015 Marketplace enrollment figures are published here:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MarketplaceProducts/Effectuated Quarterly Snapshots.
February 2016-2022 data are from the CCIIO Enrollment Payment System and beginning in 2017 have been published in the Effectuated Enrollment
Snapshot for the respective year.

**Effectuated Marketplace enrollment for 2023 was estimated applying the February 2022 state effectuated rates to the 16.4 million people who made
plan selections during the 2023 Open Enrollment Period, https://www.cms.gov/files/document/health-insurance-exchanges-2023-open-enrollment-
report-final.pdf.

# Medicaid enrollment data, 2014-2021, are from the February monthly enrollment (ever enrolled during the month) for the expansion

adult eligibility group, as reported by states through the Medicaid Budget and Expenditure System (MBES). 2022 and 2023 Medicaid enrollment

data are from September 2021 and September 2022 monthly enrollment reports respectively, as this is the most recent available monthly enrollment
count from MBES. Published reports and detailed data information for Medicaid enrollment data, including caveats, can be found at:
https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/medicaidenrollment-data-collected-
through-mbes/index.html

+ BHP programs did not start until 2015. BHP enrollment data are based on average monthly (for Minnesota) or quarterly (for New

York) projected enrollment submitted by the states to CMS in advance of the applicable quarter and are rounded to the nearest thousand. BHP
enrollment data for 2021 is through May 2021. BHP enrollment data for 2022 is through March 2022. BHP enrollment data for 2023 is projected for the
second quarter of 2023 for New York and June 2023 for Minnesota.

 

 

March 2023 ISSUE BRIEF 4
Figure 1, ACA-Related Enrollment: Marketplace, Medicaid Expansion,
and the Basic Health Program, 2014-2023

45,000,000
40,000,000 =
35,000,000 Zz
30,000,000 z=
- = la lz ia
25,000,000
20,000,000
15,000,000
10,000,000
5,000,000
0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
@ Marketplace Enrollment @ Medicaid Expansion Group, Newly-Eligible

Medicaid Expansion Group, Previously Eligible ® BHP Enrollment

TOTAL

Table 2 presents the most recent enrollment estimates by state for Marketplace and Medicaid expansion
coverage. Table 3 presents uninsured rates in 2013 (before the ACA) and 2021 (the most recent state
uninsured data). Figure 2 illustrates the percentage change in the uninsured rate from 2013-2021 for each
state. Nationally, the uninsured rate has decreased 5.9 percentage points (from 14.5% to 8.6%) since the ACA
coverage provisions were implemented in 2014. All states experienced reductions in their uninsured rates,
with 11 states - California, Kentucky, Louisiana, Michigan, Montana, New Hampshire, New York, Oregon,
Rhode Island, Washington, and West Virginia, all of which expanded Medicaid - reducing their uninsured rate
by at least half. The uninsured rate in 2021 varied widely across the country. Massachusetts had the lowest
uninsured rate at 2.5% and experienced one of the smaller relative reductions under the ACA because it had
already implemented large coverage expansions prior to 2014. Texas, which has not expanded Medicaid, had
the highest uninsured rate in both 2013 (22.1%) and 2021 (18.0%). State decisions regarding the ACA Medicaid
expansion are a main driver of variability in coverage rates across states. The Census Bureau's gold-standard
estimates of the uninsured population, which come from the ACS, are not yet available for 2022.

 

March 2023 ISSUE BRIEF 5
Table 2: Marketplace Enrollment and Medicaid Expansion Enrollment by State

California
Colorado

pF Cle)
District of Columbia

Georgia

Kentucky
Louisiana

Maryland
Massachusetts

Nebraska
Nevada

New Hampshire
Rea

New York?
North Carolina
North Dakota

Oklahoma
Oregon
NEALE)
Rhode Island
South Carolina
South Dakota
Batt)
er

Vermont

 

Wiest)

Marketplace
Plan Selections

January 2023*

258,327
25,572
235,229
100,407
1,739,368
201,758
108,132
34,742
14,768
3,225,435
879,084
21,645
79,927
342,995
185,354
82,704
124,473
62,562
120,804
63,388
182,166
232,621
322,273
118,431
183,478
257,629
53,860
101,490
96,379
54,557
341,901
40,778
214,052
800,850
34,130
294,644
203,157
141,963
371,516
29,626
382,968
47,591
348,097
2,410,810
295,196
25,664
346,140

Marketplace

Effectuated
fee) a4

February 2023+

245,000
24,000
222,000
93,000
1,718,000
180,000
92,000
33,000
13,000
3,106,000
825,000
20,000
78,000
322,000
175,000
79,000
118,000
57,000
115,000
60,000
168,000
201,000
306,000
112,000
169,000
243,000
52,000
96,000
93,000
52,000
330,000
32,000
198,000
767,000
33,000
278,000
193,000
133,000
358,000
30,000
365,000
46,000
330,000
2,283,000
287,000
25,000
330,000

Medicaid Expansion
Newly Eligible

September 2022#

N/A
71,602
190,742
326,906
4,910,970
594,987
332,700
14,685
89,169
N/A
N/A
30,643
126,920
902,256
572,082
192,323
N/A
627,546
750,379
83,831
451,214
0
967,247
297,797
N/A
260,132
117,275
64,901
362,226
91,146
740,380
296,146
432,535
N/A
33,108
862,854
334,632
598,132
1,078,203
98,299
N/A
N/A
N/A
N/A
131,599
0
685,404

Medicaid Expansion
Previously Eligible

September 2022#

N/A
2
517,200
15,599
30,486
7,352
31,003
78,706
44,973
N/A
N/A
150,021
0
99,111
0
62,490
N/A
0
0
21,530
0
476,916
60,396
0
N/A
0
0
1,355

488
0
0
2,088,587
N/A
1,686
223
0
108,818
64,957
0
N/A
N/A
N/A
N/A
935
75,920
0

Total
ACA-Related

Coverage

245,000
95,604
929,942
435,505
6,659,456
782,339
455,703
126,391
147,142
3,106,000
825,000
200,664
204,920
1,323,367
747,082
333,813
118,000
684,546
865,379
165,361
619,214
677,916
1,333,643
505,419
169,000
503,132
169,275
162,256
455,226
143,634
1,070,380
328,146
3,863,003
767,000
67,794
1,141,077
527,632
839,950
1,501,160
128,299
365,000
46,000
330,000
2,283,000
419,534
100,920
1,015,404

 

March 2023

ISSUE BRIEF 6
Table 2: Marketplace Enrollment and Medicaid Expansion Enrollment by State, (cont'd)

Marketplace Marketplace Medicaid Expansion Medicaid Expansion Total

Plan Selections au LI Wa art le) (3) Previously Eligible ACA-Related
fee) a4

January 2023* February 2023+ September 2022# September 2022# Coverage
Washington 230,371 203,000 803,639 18,624

  
 

1,025,263

     

West Virginia 28,325 26,000 239,001 0 265,001
221,128 213,000 N/A N/A 213,000
rity 38,565 37,000 N/A N/A 37,000
N/A N/A N/A 5,488 5,488
Puerto Rico N/A N/A N/A 667,162 667,162
Viele N/A N/A N/A 18,315 18,315
Total 16,357,030 15,567,000 18,765,611 4,648,343 40,220,457

Notes:

* 2023 plan selections from states with HealthCare.gov Marketplaces for the Open Enrollment Period of November
1, 2022 to January 15, 2023. Dates through which data are reported vary for State Based Marketplaces. health-
insurance-exchanges-2023-open-enrollment-report-final.pdf (cms.gov). State totals do not add up due to rounding.
*Effectuated Marketplace enrollment for 2023 was estimated applying the February 2022 state effectuated rates to
the 16.4 million people who signed-up for coverage during the 2023 Open Enrollment Period, health-insurance-
exchanges-2023-open-enrollment-report-final.pdf (cms.gov).

# Medicaid Data: September 2022 enrollment of newly eligible population as reported on the CMS-64., Awaiting
state reporting, enrollment reasonableness review is in progress. Enrollment only applicable for states that have
expanded their Medicaid programs to adults with incomes up to 138% FPL (the "adult group"). For the states that
have not expanded Medicaid their enrollment is noted as "N/A." Massachusetts and Vermont already offered
subsidized coverage to those with incomes below 138% FPL, so they are listed as having 0 newly-eligible adults,
even though they have implemented the ACA's Medicaid expansion.

1 Minnesota total includes an estimated 95,622 Basic Health Plan enrollees as of June 2023.

2 New York total includes an estimated 1,143,881 Basic Health Plan enrollees as of April-June 2023.

Table 3: Uninsured Rates for 2013 and 2021

Uninsured Rate %*

California

Colorado
(elas

pr TC

District of Columbia

Georgia

 

 

March 2023 ISSUE BRIEF 7
Table 3: Uninsured Rates for 2013 and 2021 (cont'd)

Louisiana

Maryland

Massachusetts

TTL c)
Nevada

New Hampshire

New York
North Carolina

North Dakota

(eel ied ure]
Oregon
Pennsylvania
Rhode Island
Ro MOT) re)
South Dakota
aU et (3)

ach

Vermont
Virginia
Washington

Nees Ae ale)

Medea tay

Total

 

Wt tA

2013
16.6
11.2
10.2

3.7
11.0
8.2
17.1
13.0
16.5
11.3

20.7
10.7
13.2
18.6
10.7
15.6
10.4
11.0
17.7
14.7

9.7

11.6
15.8
11.3
13.9
22.1
14.0

7.2

12.3
14.0
14.0

9.1

13.4

14.5

Uninsured Rate %"

2021
7.6
5.7
6.1
2.5
5.0
4.5

11.9
9.4
8.2
7.1

11.6
5.1
7.2

10.0
5.2

10.4
7.9
6.5

13.8
6.1
5.5
4.3

10.0
9.5

10.0

18.0
9.0
3.7
6.8
6.4
6.1
5.4

12.2
8.6

* Uninsured Rates: American Community Survey, "Health Insurance Coverage Status and Type of Coverage by State
and Age for All People", 2013,2021: https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-

hi.2013.html.

 

March 2023

ISSUE BRIEF
Figure 2: Relative Reduction in the Uninsured Rate by State, 2013 to 2021

    

me oe
@
9% to -30%
-30 to -40%
GS -40% to-45%
Mm -45% to 49%
Mi 50% to 63%
CONCLUSION

The ACA's multiple programs have led to an historic expansion of health coverage, with an estimated 40
million people currently enrolled in coverage related to the law. Gains have accelerated since 2021,
concurrent with efforts by the Biden-Harris administration to expand coverage. These efforts include:
enhanced subsidies for Marketplace coverage under the American Rescue Plan and later extended by the
Inflation Reduction Act; robust outreach efforts to sign up eligible individuals for coverage; and ongoing
support for state Medicaid expansions.

Under the Consolidated Appropriations Act, 2023 the Medicaid and CHIP continuous enrollment provision for
the COVID-19 public health emergency will come to an end on March 31, 2023. ASPE previously estimated
that 15 million enrollees could lose their Medicaid or CHIP coverage based on historical patterns, though many
will be eligible to obtain alternative coverage.® About 8.2 million Medicaid enrollees are estimated to leave
Medicaid due to loss of Medicaid eligibility and another 6.8 million are estimated to lose Medicaid coverage
despite still being eligible ("administrative churning"). HHS is working with states to minimize administrative
churning to reduce the number of Medicaid and CHIP enrollees who remain eligible but fail to complete the
redetermination application. Of the 8.2 million Medicaid enrollees estimated to lose Medicaid or CHIP
eligibility, 5 million can likely transition to other coverage, primarily employer health plans, and 2.7 million are
expected to be eligible for Marketplace premium tax credits (1.7 million of the 2.7 million are expected to be
eligible for zero-premium Marketplace plans). The Administration closed the "family glitch" so that starting
with the 2023 Marketplace plan year, family members of a person who is offered employer-based insurance
that is only "affordable" for self-only coverage, and not the whole family, may be eligible for tax credits on the
Marketplaces for the first time to help the family enroll in a Marketplace plan with savings.°

Of note, estimates of ACA-related coverage presented in this Issue Brief are a conservative estimate of the
law's impact on health insurance coverage for several reasons. First, the effectuated enrollment estimate for
the Marketplace is a more conservative estimate than plan selections. Second, the total does not include the

 

March 2023 ISSUE BRIEF 9
provision of the ACA that took effect in 2010 allowing young adults to remain on their parents' plans until age
26, which previous research estimated led to more than 2 million young adults gaining insurance; this
provision, like many other private insurance market reforms in the ACA (such as banning lifetime limits on
medical expenses and guaranteed issue for those with pre-existing conditions), has become embedded in the
health insurance system, making updated estimates of the numbers of Americans benefiting from the ACA
more difficult, but it nonetheless remains an important part of the ACA's impact.?° Third, the streamlining of
Medicaid applications, enhanced outreach, and expanded eligibility led to increased enrollment even among
children and parents who were eligible for Medicaid through traditional pre-expansion pathways, a
phenomenon referred to as the "welcome mat" effect.' Thus, 40.2 million likely underestimates the total
effect of the ACA.

 

March 2023 ISSUE BRIEF 10
HP-2023-08

REFERENCES

 

1 As amended by the Health Care and Education Reconciliation Act of 2010.

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hi.2013.html.

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at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/downloads/november-2022-
medicaid-chip-enrollment-trend-snapshot.pdf.

7 Medicaid CMS-64 FFCRA Increased FMAP Expenditure Data Collected through MBES. Medicaid.gov. Accessed at:
https://www.medicaid.gov/medicaid/financial-management/state-budget-expenditure-reporting-for-medicaid-and-
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mbes/index.html.

5 Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Unwinding
the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches. (Issue Brief No. HP-
2022-20). August 2022. Accessed at: https://aspe.hhs.gov/reports/unwinding-medicaid-continuous-enrollment-provision.
° Marketplace Open Enrollment Fact Sheet. Centers for Medicare and Medicaid.
https://www.cms.gov/files/document/102622-landscape-and-window-shopping-508.pdf.

10 Uberoi, N., Finegold, K., & Gee, E. (March 3, 2016). Health insurance coverage and the Affordable Care Act, 2010-2016.
Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and
Evaluation. Accessed at: https://aspe.hhs.gov/system/files/pdf/187551/ACA2010-2016.pdf.

11 Hudson, J. and Moriya, A. "Medicaid Expansion for Adults Had Measurable 'Welcome Mat' Effects on their Children".
Health Affairs, September 2017.

 

March 2023 ISSUE BRIEF 11
 

 

HP-2023-08
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Assistant Secretary for Planning and Evaluation

200 Independence Avenue SW, Mailstop 447D
Washington, D.C. 20201

For more ASPE briefs and other publications, visit:
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a

SUGGESTED CITATION

Office of the Assistant Secretary for Planning and Evaluation, U.S.
Department of Health and Human Services. Health Coverage

Changes Under the Affordable Care Act: Current Enrollment and
State Estimates. (Issue Brief No. HP-2023-08). March 2023.

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March 2023 ISSUE BRIEF 12