Tennessee ACA enrollment spikes 27% as non-Medicaid expansion states lead record growth

Nationwide, enrollment in Affordable Care Act Marketplace plans has hit another record, jumping 13% from last year’s record. But almost all of the gains are from states like Tennessee that have refused to expand Medicaid.

The open enrollment period ended Jan. 15 for most states. In Tennessee, there are now nearly 350,000 people (state-by-state figures here) with marketplace plans — most with big government subsidies. That’s up roughly 74,000 from last year, a 27% bump (figures for prior years here).

The Biden administration has been spending more money to market the open enrollment period, restoring funding that was cut under President Trump. And Biden extended more generous subsidies, which make it so some people can even get a plan for free.

The national increase was 1.8 million. And just a handful of states are responsible — including Texas, Florida, Georgia and North Carolina. Texas, alone, spiked nearly 600,000 — up roughly a third from the prior year.

“Of the people who are eligible for free plans, most of them are concentrated in those states,” says Cynthia Cox, vice president at the Kaiser Family Foundation and director of its ACA program. “So I think that that really does underscore that when you make plans affordable and you make sure that people know about that, then people will come to the door.”