Enhanced subsidies enacted through the American Rescue Plan Act bolstered health insurance affordability and, consequently, most states across the country saw record-level enrollments for 2022. In fact, several states saw year-over-year increases of more than 30 percent. This is great news for Americans and provides states yet another reason to set up their own health insurance exchanges.

For those states operating their health insurance exchanges on HealthCare.gov, these additional enrollments translate into billions of incremental dollars in user fees to the federal government that could be used in the state to support enhanced enrollment efforts and assistance if they were operating their own exchanges. When a state sets up their own health insurance exchange, they can use the savings realized from not paying federal user fees to lower consumers’ monthly premiums, set up reinsurance pools, develop enrollment efforts in underserved populations, and/or place it in the state’s general fund, to name a few examples. Whatever the state decides, the important piece is, the state gets to decide.  

wdt_ID State Platform Cumulative 2022 OEP Plan Selections FFM User fees in 2022 (Jan 27 CMS numbers)
2 Alaska HealthCare.gov 22,786 $5,436,512
4 Alabama HealthCare.gov 219,314 $56,306,676
6 Arkansas HealthCare.gov 88,226 $16,595,311
8 Arizona HealthCare.gov 199,706 $38,487,340
10 Delaware HealthCare.gov 32,113 $7,365,117
12 Florida HealthCare.gov 2,723,094 $574,218,832
14 Georgia HealthCare.gov 701,135 $131,883,494
16 Hawaii HealthCare.gov 22,327 $4,671,255
18 Iowa HealthCare.gov 72,240 $16,687,440
20 Illinois HealthCare.gov 323,427 $70,122,208

(Source: Marketplace 2022 Open Enrollment Period Report: Final National Snapshot. User fee calculations are based on plan selections.) 

If your state wants to learn more about how it can claw back these budget dollars, email hello@getinsured.com.