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ACA Exchange System Keeps Growing in Its Core States

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The Affordable Care Act (ACA) public exchange system ended up with about as many individual and family major medical insurance signups for 2020 as it had for 2019.

Charles Gaba has compiled preliminary data on the latest signup totals for his tracking blog.


  • A copy of Charles Gaba’s Feb. 20 ACA public exchange enrollment chart is available here.
  • An article about 2020 ACA public exchange signup activity is available here.

The total number of signups fell to 11.42 million for 2020, from 11.44 million for 2019, according to Gaba.

ACA Public Exchange Basics

The ACA public exchange system provides a kind of web-based shop for health insurance.

Some states run their own ACA public exchange programs.

The U.S. Department of Health and Human Services (HHS) provides ACA exchange services for residents of other states through

HHS reports public exchange activity in terms of signups, rather than sales, because consumers who sign up for coverage must send in payments to effectuate the coverage. HHS and many states report on signups too quickly to have complete data on how many of the people who signed up for coverage sent in payments.

The Gorilla States

Although the total number of ACA public exchange signups was down 0.2% this year, some states had better results than others.

Mississippi showed the biggest signup growth, and Virginia reported the biggest signup drop.

The number of signups increased 12% in Mississippi, to 98,892, and fell 18% in Virginia, to 269,474.

The 2020 signup numbers for the states with the most public exchange users in 2019 suggest that, in those states, success is breeding success.

The five states that had more than 400,000 ACA exchange signups for 2019 all produced more signups for 2020.

Here are how those five states did:

  • Florida ( 1.9 million (up 7.3%)
  • California (state-based): 1.5 million (up 1.6%)
  • Texas ( 1.1 million (up 2.7%)
  • North Carolina ( 505,275 (up 0.8%)
  • Georgia ( 463,910 (up 1.2%)

— Read Signs More Individual Health Producers, on ThinkAdvisor.

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