Americans can start signing up for health care coverage offered through the Affordable Care Act marketplace for 2025.
The open enrollment period began Friday and ends Jan. 15, but to have coverage in the new year you must enroll by Dec. 15.
Billions of dollars in tax credits are also at stake. Established during the COVID-19 pandemic, the money has expanded eligibility for millions of Americans, made health insurance coverage more affordable for many and dramatically boosted enrollment.
Nearly all of the 21 million people in the program have benefited from those subsidies, which expire next year, the U.S. Health and Human Services Secretary Xavier Becerra said in an interview with The Associated Press.
“Americans can actually look at health care not as a privilege, but now as a right,” said Becerra, who is going to the political swing state of Arizona on Friday to mark the beginning of open enrollment. “I don’t think anyone wants to have a right yanked away from them to have affordable health insurance coverage.”
Significant changes to the program are possible if former President Donald Trump wins the White House again and Republicans take control of Congress in Tuesday’s elections. They are threatening to scale back the ACA, also known as Obamacare.
“Health care reform’s going to be a big part of the agenda,” House Speaker Mike Johnson said Monday during a Pennsylvania campaign stop, in a video first obtained by NBC News.
Johnson’s office later issued a statement saying that he had no plans to completely repeal the landmark legislation, but the comments still underscored how Johnson is working closely with Trump to potentially remake the federal government and its social programs if Republicans sweep into power.
Trump has only said that he has “concepts of a plan” to change the Affordable Care Act, which he was unable to successfully scuttle altogether during his previous term in office. In recent months, Republicans have raised concerns about spending and fraud.
Enrollment under the Biden administration surged, after years of declines during the Trump administration, dropping to a low of 11 million on Trump’s watch. But taxpayers have had to pour billions of dollars more into the ACA to achieve that increase. That money has helped pay for subsidies to cut premiums by nearly half for many of those enrolled in the program.
Congress would need to pass a new law to continue those subsidies, which could cost as much as $335 billion over the next decade. Some Republicans have already balked at that figure.
The Biden administration has expanded the program in other ways that Democrat Vice President Kamala Harris is likely to continue is she defeats Trump, but Trump is sure to pull back on. For example, the administration poured more money into hiring health insurance navigators who help enroll people into coverage.
The White House also implemented a new rule that expands eligibility for the program to immigrants who were brought to the U.S. as children. About 100,000 of those immigrants, also called “Dreamers” are expected to sign up for the coverage for the first time during enrollment this year.
Republican attorneys general in 15 states have sued to block their enrollment.