General Discussion

Since the enhanced tax credits became available, ACA Marketplace enrollment has soared, more than doubling to 24.3M people since 2020. While nearly all states’ Marketplaces grew since the introduction of the enhanced tax credits, some red states stand out as having a larger share of their population enrolled in ACA Marketplaces.

Nearly six in ten Marketplace enrollees (57%) live in congressional districts represented by a Republican. Generally, enrollment in ACA Marketplace coverage by congressional district is largest in the South. At least 10% of the population is enrolled in ACA Marketplace plans throughout all congressional districts in Florida, Georgia, Mississippi, and South Carolina, along with almost all in Texas and Utah.

While a relatively small share of the national population gets their coverage through the ACA Marketplaces, in some districts, the number of ACA enrollees could be enough to swing a close election. For example, in the 10 most competitive districts in the last election, the margin of victory was fewer than 6,000 votes. There are at least 27,000 ACA Marketplace enrollees in each of these districts. (About 9 in 10 enrollees nationwide are voting age). Republicans currently represent 5 of these 10 districts.

In Florida, there are 10 congressional districts where at least 20% of the population is enrolled in a Marketplace plan. The top 5 congressional districts by ACA Marketplace enrollment are all in Florida and represented by a mix of Democrats and Republicans.