Obamacare enrollment drops after enhanced premium subsidies expire

(CNN) — More than a million fewer people have signed up for Affordable Care Act coverage for 2026, according to federal data released Wednesday. The drop comes after the expiration of the enhanced federal premium subsidies caused monthly payments to skyrocket for many enrollees.

Just under 23 million people selected plans for 2026, according to the Centers for Medicare and Medicaid Services. That compares to just under 24.2 million people in roughly the same period last year. The data includes all sign ups in the 30 states using the federal exchange, where open enrollment ended January 15. But it doesn’t capture full enrollment in all the states that run their own exchanges, a few of which are allowing people to sign up through the end of this month.

However, total enrollment is likely to fall in coming months, experts said. A sizeable share of consumers were automatically reenrolled in policies and may not realize how much their premiums will rise until they get their first bill. This may prompt them to drop coverage or simply not pay, which will result in their being disenrolled in April.

“That number does not tell the full story. These numbers are going to go dramatically down month after month as people decide that they can’t afford health care and stop paying their premiums,” Leslie Dach, chair of Protect Our Care, an advocacy group, said in a statement.

Those who keep their coverage are likely contending with higher premium payments or higher deductibles due to the lapsing of the enhanced premium subsides, said Cynthia Cox, director of the Program on the ACA at KFF, a health policy research group. Premium payments are expected to climb by 114%, on average, this year, according to KFF.

The Congressional Budget Office projected that 2 million fewer people would have Obamacare coverage this year due to the ending of the more generous federal subsidies.

The enhanced assistance was enacted by the Biden administration as part of a 2021 Covid-19 relief package, but it expired at the end of 2025. The additional aid had spurred a large spike in Obamacare enrollment, particularly among low-income Americans who could get policies with no or very low premiums. The enhanced subsidies also made coverage more affordable for middle-class enrollees, who previously didn’t qualify for help.

The lapsing of the subsidies sparked a fierce partisan battle on Capitol Hill that led to a record-long government shutdown last fall. Democrats insisted on tying funding the federal government to extending the subsidies but eventually relented as the shutdown dragged on. The House last month passed a three-year subsidy extension after several Republican lawmakers voted with the Democrats, but the legislation has been unable to advance in the Senate amid stiff opposition from the GOP.

The decline in sign ups for 2026 is the first drop since 2020, when 11.4 million people picked plans. Enrollment gradually slid throughout President Donald Trump’s first term.

Fewer enrollees

Interest in Obamacare policies for 2026 fell among new customers in particular. Just under 3.4 million new consumers signed up for policies, down 14% from a year earlier. Returning customers numbered just under 19.6 million, a decline of 3%.

The largest drops in overall signups include North Carolina, with a 22% plunge, and Ohio, with a 20% decline, Cox said. But the biggest increases were in New Mexico, where plan selections soared 14%, and the District of Columbia, with a 9% jump.

Several states that run their own exchanges saw their enrollment dip as a larger number of people canceled their plans for this year.

In Colorado, just over 277,000 people selected policies by the end of the state’s enrollment period, down 2% from last year. The number of new enrollees slid by nearly a quarter. This comes even as the state enacted its own premium assistance program to help replace the enhanced federal subsidies.

“On one hand, it’s encouraging to see enrollment remain relatively steady, with only a slight dip, and to see so many people receive meaningful financial assistance,” Kevin Patterson, CEO of Connect for Health Colorado, said in a news release. “On the other hand, it’s deeply troubling that a record number of people are canceling their plans because they simply can’t afford their monthly payments or are being forced to choose between health care and basic necessities like housing and food.”

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