Additional Coverage:
- ACA health insurance enrollment dropped by 1.4 million. See which states had the biggest swings. (businessinsider.com)
Millions Face Health Insurance Sticker Shock as ACA Subsidies Vanish
Washington D.C. – Millions of Americans are grappling with significantly higher health insurance costs this year, following the expiration of Affordable Care Act (ACA) subsidies. A recent report from the Centers for Medicare & Medicaid reveals a sharp decline in marketplace enrollment, with 1.4 million fewer individuals signing up for coverage in January 2026 compared to the previous year.
The report highlights substantial dips in states across the South and Southeast, with Florida alone seeing a decrease of over 260,000 enrollees. While a few states, like Texas and California, experienced an increase, the overall trend points to a widespread impact on low- and middle-income households.
“People have less access to care, and that tends to translate into worse health outcomes,” stated Matthew Fiedler, a senior fellow at The Brookings Institution. Fiedler also warned of the financial instability facing many households, noting, “People will face big bills that they either can’t pay, and that hurts their credit. Or they do pay, but it requires them to skimp in other areas.”
The enhanced ACA subsidies, enacted in 2021, made health insurance more affordable for those earning up to 400% of the poverty line – an annual income of $128,600 for a family of four. Without these credits, a KFF estimate projects that out-of-pocket premium costs for marketplace enrollees could more than double from last year.
White House Spokesperson Kush Desai attributed the enrollment decline to “the Trump administration’s commonsense measures to cut waste, fraud, and abuse and remove people who were improperly enrolled on highly-subsidized ACA plans.” However, the expiration of these subsidies was a point of contention in Congress, contributing to a recent government shutdown, and efforts to renew them remain stalled.
Republicans have expressed a desire for a compromise healthcare strategy. A plan released by President Donald Trump on January 15 outlines goals to reduce drug prices and insurance premiums, implement cost-sharing programs, and increase cost transparency, but notably does not include mention of subsidies. Gideon Lukens, senior fellow and director of research and data analysis at the Center on Budget Policy and Priorities, criticized the plan’s lack of detail, calling its basic contour “contradictory.”
Further Enrollment Declines Expected
Policy analysts anticipate an even steeper drop in ACA enrollment in the coming months. The January data reflects individuals who selected a marketplace plan or were automatically renewed, but does not account for those who have yet to pay their premiums.
Experts believe many individuals may drop coverage once they receive their initial bills. A Congressional Budget Office report estimates that nearly 4 million Americans will lose or drop insurance over the next decade.
“Many likely signed up when the premiums they would end up facing were uncertain and then waited to see what they would have to pay,” explained Matthew Buettgens, a senior fellow at The Urban Institute.
In states where enrollment saw an increase, such as California, local healthcare policies may be a contributing factor. California, for example, offers its own ACA subsidies, providing a buffer against federal changes.
Beyond the immediate impact on patients, Fiedler warned that the lapse of ACA credits could strain hospitals, potentially leading to an influx of uninsured patients and a decreased likelihood of individuals seeking necessary care. “There will be facilities that were already financially fragile for whom this is the straw that breaks the camel’s back,” he concluded.