New data published in early 2025 by the Centers for Medicare & Medicaid Services (CMS) on nearly 24 million people insured in the Marketplaces at the beginning of this year may have sparked considerable enthusiasm among supporters of expanding government influence in healthcare. After all, this figure represents a new record with over 3 million new insured individuals. So everyone should have reason to be happy, right?

However, a closer look at the data casts doubt on this new milestone introduced by Obamacare. In this case, this is because many people equate the mere fact of having insurance with easy access to medical services. Nothing could be further from the truth, especially when government interventionism heavily regulates the private health insurance market.

The Interventionism of Obamacare

The main changes consisted in the creation of special and strictly-regulated Marketplaces through which the uninsured can purchase health insurance plans at affordable (i.e., heavily-subsidized) prices. In order to overcome market failure, these “markets” have been subject to numerous regulations. The most important of these, as described by McGuff and Murphy, are:

Mechanism to provide health insurance to (most) Americans (“universal coverage”) No price discrimination with respect to insurance premiums (“community rating”) Predetermined minimum coverage (“essential health benefits”) Obligation to have health insurance (“individual mandate”) Government subsidies for the poor Government guarantees for insurance companies

The Obamacare regulations were, therefore, another turn of the (regulatory) screw. …

One might ask why, despite increases in premiums and deductibles, these health plans continue to attract new subscribers. There are several reasons for this.

First, thanks to APTC, those who are eligible for it do not pay most of the premium. This makes a difference when, for example, instead of paying $600, you only pay $100. Regardless of the reasons for such high premiums, this situation creates a false sense of affordability.

Second, it may seem shocking, but many insured people are simply unaware of the prohibitive deductibles—they only see part of their health insurance premium. And, in the case of deductibles, we are not talking about $500 or $1,000, but several thousand dollars. This completely distorts the idea of insurance. However, as long as you don’t need a doctor, you can continue to live in ignorance.

Third, the growing number of insured persons is the result of—among other things—lowering the eligibility requirements for receiving APTC. On the government website healthcare.gov, we can read that: “If your income is above 400% FPL, you may now qualify for the premium tax credit that lowers your monthly premium for a Marketplace health plan.” It is therefore clear that such solutions are more about buying political support than a desire to help the poorest. It is also worth noting the expansion of Medicaid eligibility in many states. As a result, in 2024, 1 in 6 non-elderly Americans gained access to healthcare thanks to Obamacare.

Conclusion

The increase in the number of people insured on Marketplaces is not proof of effective healthcare—it is simply a statistic. A more detailed analysis reveals problems with cost control, rising premiums and deductibles, and deteriorating quality in the form of fewer insurers and plans with limited provider networks. As usual, attempts to improve markets have the opposite effect to that intended, and this should be borne in mind in future attempts to “reform” healthcare.