Open enrollment for the Health Insurance Marketplace, established by the Affordable Care Act, has begun for a second year, right on the tails of the 2014 midterm elections.

The Republican Party, which cruised to victory in Missouri and in U.S. Congress, has made repealing the Affordable Care Act one of its top priorities.

In the last enrollment period, the marketplace signed up eight million people for insurance coverage across the country, according to the U.S. Department of Health and Human Services website.

As of July, Missouri has seen 33,299 fewer people enroll in Medicaid and the Children’s Health Insurance Program since the start of the first open enrollment period in Oct. 2013.

These changes have affected Missouri hospitals, such as the University of Missouri Health System. System spokesperson Mary Jenkins said patient admissions and revenue have increased steadily since 2011.

Jenkins said she has observed that the hospital is experiencing changes in its insurance operations as well.

“We’ve found that our negotiations with insurers have not become easier or harder since the ACA was implemented, but the focus and topics of our discussions have changed and expanded,” Jenkins said.

Julie Brookhart, Kansas City Regional Office of the Centers for Medicare and Medicaid Services spokeswoman, said she does not know how the recent turnover of party control in Congress will affect the law.

“As far as any predictions of how these numbers could change given the newly elected Republican Congress, we do not speculate on what Congress will or will not pass into law,” Brookhart said. “(CMS) implements, through programs, what is passed into law, and until the law changes, we will continue to implement the current ACA law as it stands today.”

According to the Department of Health and Human Services website, 3,034 people in Columbia enrolled in the Marketplace during the first open enrollment period. Enrollment for the Health Insurance Marketplace for the 2015 coverage period will end Feb. 15, 2015.