The report finds that targeted outreach efforts and increased affordability helped ACA enrollment across the board. The affordability of ACA plans was increased by the American Rescue Plan, a COVID-related relief law that was passed in 2021. That law provided funding in numerous areas and expanded ACA subsidies to cover more Americans. At the time of passage, the Congressional Budget Office estimated that the rescue plan's health care provisions would bring health insurance coverage to 1.3 million previously uninsured Americans.

"Access to high-quality, affordable health care is top priority of the Biden-Harris Administration, and the Affordable Care Act is central in our efforts to increase access for America's families," says HHS Secretary Xavier Becerra in a statement on Oct. 25. "This report shows that our efforts are working, including among Black, Latino, and American Indian and Alaska Native consumers. The uninsured rate is at a record low in the country, but we know we have more to do to close gaps in coverage and increase equity."

Lifting all boats

The new report finds that Latino consumers saw a 53% increase in ACA enrollment from 2020, and Black consumers saw a 49% increase in enrollment from 2020.

However, Latino and Black Americans are not the only groups that saw an increase in enrollment over the past two years. ACA enrollment for American Indian and Alaska Native enrollees increased from 52,000 to 68,000 (a 32% increase); White enrollees saw an increase from 4.7 to 5.2 million (an 11% increase); and Asian-American, Native Hawaiian, and Pacific Islander enrollees increased from 0.8 million in 2020 to just under 0.9 million in 2022 (a 6% increase).

The numbers are estimates, officials note, since more than 30% of marketplace enrollees have missing race and ethnicity information, which is a barrier to measuring coverage rates.

However, similar studies from sources such as the Commonwealth Fund also finds increases in ACA enrollment and more outreach to underserved populations.

More investment in outreach and education

HHS officials say the sharp increases for underserved populations is a result of a careful strategy to address traditional inequities.

"Improving racial health equity and increasing access to affordable health coverage are priorities of the Biden- Harris Administration," the report says. "The Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government prompted [HHS] to initiate an Equity Action Plan, which emphasizes advancing equity as a central component of all agency decision-making."

In June, the Commonwealth Fund notes that collecting race and ethnicity data is inconsistent across states, with some states doing much better than others. The study says that more can be done by insurers, brokers, and state agencies to gather that information.

"State-based marketplaces can address these challenges and increase response rates by changing the application process," the Commonwealth Fund article says. "New York's marketplace made multiple changes to its 2022 application process and saw a 45% drop in the percentage of enrollees with missing race or ethnicity data."

New approach brings record low to uninsured rates

The new emphasis on marketing and education, paired with the making plans more affordable, has had results. In August, HHS estimates that the uninsured rate in early 2022 had reached an all-time low in the U.S., at 8% among all U.S. residents. That report shows that 5.2 million people had gained health insurance coverage since 2020 (including employment-based insurance).

Related: ACA rates expected to substantially increase in 2023

"The 2022 Open Enrollment Period saw an all-time high in Marketplace sign-ups of 14.5 million, following administrative and legislative actions such as an extended 2021 special enrollment period and implementation of expanded Marketplace subsidies under the American Rescue Plan," the August statement says. "In addition, recent adoption of the ACA Medicaid expansion in several states has extended Medicaid coverage to low-income adults up to 138% of the Federal Poverty Level (FPL)."