The Department of Health and Human Services announced on January 17, 2025, that 24.2 million Americans had enrolled in Affordable Care Act marketplace health plans for the 2025 coverage year — a record high and the fifth consecutive year of enrollment growth. This represented an increase from 21.4 million in 2024. The figure was confirmed by HHS, Fox News, NPR, CNBC, and the Kaiser Family Foundation.

The record enrollment was driven largely by enhanced premium subsidies enacted in the 2021 American Rescue Plan, which eliminated the income cap on subsidy eligibility and significantly reduced premiums for middle-income earners. Those subsidies had been extended through 2025 via the Inflation Reduction Act. Without renewal by Congress, they were scheduled to expire at the end of 2025, which analysts said would likely cause 4–5 million people to drop coverage.

The Biden administration framed the enrollment record as evidence of the ACA's success in expanding coverage. The uninsured rate had fallen to a record low of 7.7% of the population in 2024. President Biden said the numbers showed 'the American people want and need affordable health care.'

Republican lawmakers and the incoming Trump administration had signaled they would seek to let the enhanced subsidies expire without renewal, or allow states more flexibility to offer cheaper, less comprehensive plans. Fox News noted that enrollment growth was partly artificial — driven by below-market subsidized premiums — and that the cost to taxpayers had risen sharply. NPR emphasized that millions of lower-income Americans who had gained coverage for the first time stood to lose it if subsidies were cut.