- On social media, it said that 7% of the US population is on an ACA policy.
- Others claim it’s 14%-15% or “1 in 7 in the US are on ACA policies”.
- One government agency says 24 million are on ACA policies as of 2024 and 2025.
- One person claims this includes “family” policies, and therefore, there may be more than 1 person per “policy” – and thus, there are 40-45 million people on ACA policies.
- Another says 45 million are on ACA policies.
- Another says “50 million people have been on ACA policies”
Can all of these statements be true simultaneously?
Yes, but only if you understand they are measuring different things – details matter.
Unfortunately, these inconsistent and contradictory numbers are deliberately used, mostly, to mislead people.
Official CMS Number for ACA Individuals Enrolled
Official CMS number: 24.2 million (but then in the PR, they use a sleight of hand to say 50 million – which is a cumulative total) See https://cms.gov/newsroom/press-releases/over-24-million-consumers-selected-affordable-health-coverage-aca-marketplace-2025
CMS does not explain their “cumulative total” but the US Treasury does: https://home.treasury.gov/news/press-releases/jy2567
The 50 million refers to how many individuals have had an ACA policy, at least once, since 2014. It is not a measure of how many are enrolled today.
The CMS itself explains that the “24 million” refers to individual people enrolled in ACA market place coverage. This is a count of individuals, not “policies” with multiple people per policy. See https://cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left
With that number, approximately 7% of the population is covered by ACA policies per CMS.
Official HHS number: 45 million, but they combine ACA individuals enrolled WITH those on the ACA Medicaid expansion. See https://aspe.hhs.gov/sites/default/files/documents/b07715d223280dc544cf26fcd19040fb/aspe-health-coverage-under-aca.pdf)
Using the HHS number, about 1 in 7 are counted, but they are combining two categories – ACA market place individual policies, plus the persons on Medicaid due to the ACA’s expansion of Medicaid.
Another Summary and Explanation
“Cumulative vs. Current Coverage
The 50 million figure from the U.S. Treasury refers to the cumulative total of Americans who have been covered by ACA policies since its implementation in 2014. This number reflects all individuals who have utilized ACA coverage at any point during that time frame.
Current Number of Covered Individuals
The 24 million figure reported by the Centers for Medicare & Medicaid Services (CMS) reflects the number of individuals actively enrolled in ACA health insurance plans in 2024. This is a snapshot of those currently covered under the ACA, distinct from the cumulative total.
Inconsistent, Contradictory and Misleading Numbers
The numbers provided by the government itself are inconsistent, contradictory and misleading.
Ultimately, every number quoted is accurate in some context:
- 7.2% are on ACA policies
- 14% are on ACA policies, broadly defined to included Medicaid expansion
- 14% have been on regular ACA policies cumulatively, from 2014 or 1 in 7
People use these numbers interchangeably, yet they are not measuring the same things.
Yet if we are confused, it is our fault.
Intentionally Obfuscating ACA Numbers and Claims
The confusion is deliberate, of course. Promoters of the ACA want to use the largest possible numbers – so they start combining groups, or using cumulative totals, to intentionally mislead. Others have used the smaller values (7.2%) partly to suggest the ACA markets are small (which is true) – and that may be they do not matter.
There are 2 other misleading arguments used in ACA discussions.
The ACA preventing people from losing their insurance due to pre-existing conditions. This claim is repeatedly widely on social media as the Obama era politicians repeatedly lied about this issue.
Most everyone in the US already had some form of pre-existing condition protections long before the ACA.
The HIPPA act of 1996 added pre-existing condition protections for those in group plans (i.e. employer plans) but it did not address the small individual market. A slight majority of US states enacted state-level protections for their own individual markets. Most people in the US had pre-existing condition protections before the ACA was enacted. The ACA extended protections into the small individual market, which was neglected in HIPAA.
The ACA Premiums Went Up Because Republicans Ended the Mandate to Buy Insurance
And this resulted in too few people in the insurance pools.
However, the mandate was ended 5 years after the ACA took effect (voted on in 2019) – even with the mandate in place the first five years, the individual markets enrolled only half the number of people that had been forecast by Jonathan Gruber, PhD of MIT – who developed much of the ACA “architecture”.
The insured pools actually grew larger AFTER the government expanded subsidies in 2021. Yet premiums continued to skyrocket – with the actual values hidden by subsidy payments.
The Pools Were Too Small
If they wanted to increase the size of the pool there were steps they could have written into the ACA. They let young people stay on parents’ policies until age 26, removing many from the individual pool.
They could have required government workers to purchase policies in the ACA individual market, creating a larger pool. But they didn’t do that either. By design, they ended up with small pools, by each insurer in each state, that were not large enough to spread the risk.
The ACA Concentrated Risk into the Small Individual Market
Pre-ACA, 35 states ran their own “high risk/high cost” subsidized insurance programs to insure persons who had conditions excluded (in the individual markets) by insurance companies. These patients were often very expensive to provide health care for.
When the ACA eliminated pre-existing conditions for the individual market, all of the 35 state run pools were closed and all of the patients were merged into the small, per insurer, per state, insurance pools. This effectively turned many ACA insurance pools into high risk/high cost insurance.
In one state, Iowa, in one year, the Blue Cross insurer note that one individual patient had accounted for 25% of fall of their health care payments – which resulted in them having to raise rates sharply.
Defects
Ultimately, the ACA failed because of numerous design defects.
Today, premiums are sky high – many thousands of dollars per month for many – and it can only function due to huge government subsidies. These subsidies will climb ever higher, every year – and this is not sustainable.
The ACA – from its inception – and due to serious design defects – was always destined to eventually fail.
In the 15 years since it was passed in 2010, the US could have fought and won World War 2 – 3 and 1/2 times! But during the time, Congress has utterly failed to make fixes to the system they created.
