As enhanced ACA subsidies lapse, millions may drop health insurance

Approximately 22.8 million Americans I have signed up so far. for 2026 health insurance through the Affordable Care Act marketplace, according to data released Monday by the Centers for Medicare and Medicaid Services. This means a decrease of approximately 1.5 million. 24.3 million people Those who have registered for health insurance for 2025.

The data marks an early sign of negative impacts from the imminent end of increased premium subsidies the federal government has offered since 2021.

Health experts now expect millions of people to drop their insurance coverage due to rising health premiums; This could threaten Republicans’ success in this year’s midterm congressional elections, as most ACA enrollment rates have increased in recent years. occurred in red statesdata shows.

Without the increased subsidies, which expire at the end of 2025, the average buyer would see their premiums more than double this year, according to health policy research group KFF.

Health experts note that enhanced ACA subsidies that make insurance more affordable for consumers have greatly reduced the number of uninsured Americans since it went into effect. Total ACA enrollment Hovered between 11 million and 12 million From 2015 to 2021, it only doubled to over 24 million by 2025 as increased subsidies took effect.

Insurance coverage is now poised to become a bigger focus as millions of Americans are expected to drop insurance altogether due to high costs.

“The health policy debate in recent years has been predominantly about costs, because the coverage issue has largely been resolved,” said Jonathan Burks, vice president for economic and health policy at the Bipartisan Policy Center. “The end of enhanced subsidies has reopened this coverage debate.”

First of all, the numbers do not yet cover the entire open enrollment period. It will last until January 15. The most recent CMS enrollment data was up-to-date as of Jan. 3 for states using the federal Healthcare.gov platform and Dec. 27 for state-based ACA exchanges. People still have time to decide whether to sign up.

The figures also include people who enroll in a health plan in 2025 and are automatically re-enrolled in the same plan in 2026.

When they start paying their first premiums in the coming weeks, they may choose to reduce their coverage if they find it too expensive, experts said.

“It’s too early to tell how big of a decline this will lead to,” Jared Ortaliza, a policy analyst at KFF who focuses on the Affordable Care Act, wrote in an email. “Compared to around the same time last year, new data released by CMS shows fewer people are enrolling in ACA Marketplace plans. If this remains true when Open Enrollment ends, this would be the first time since 2020 that year-over-year enrollment decreased.”

Jessica Banthin, a senior fellow in the Urban Institute’s health policy division and former deputy health director for the Congressional Budget Office, said the true impact of the delay in increased premium subsidies could be “hidden” by mid-year.

Usually, CMS issues a report on the “current record,” Banthin said. Health insurance choices are not enabled, or “activated,” until enrollees pay premiums, he said.

Urban Institute economists predict Total 4.8 million people Due to the end of subsidies, their health insurance will decrease in 2026 and they will remain uninsured.

“Given the overall increase in prices in the healthcare industry, the risk of having an unmanageable medical bill is real,” Burks said, noting the financial risk of foregoing coverage. he said.

Another 2.5 million people will drop ACA insurance but find alternative coverage, perhaps through employer-sponsored insurance or Medicaid, depending on their circumstances, said Banthin, who co-authored the Urban analysis.

Others are expected to remain in the ACA market but enroll in high-deductible plans that offer cheaper premiums but higher upfront care costs, experts say.

“A good healthcare system means our workforce is healthy and productive,” Banthin said. “If a large segment of our working-age population does not have access to health care, this will ultimately hurt the economy.”

Approximately 88% of total growth in the ACA market since 2020 – 11.4 million out of 12.9 million new enrollees. from such statesAccording to KFF.

KFF found that, on average, registrations increased by 157 percent in states that voted for Trump, while states that voted for former Vice President Kamala Harris saw a 36 percent increase. Enrollments more than tripled in Texas, Mississippi, West Virginia, Louisiana, Georgia and Tennessee.

Subsidies were at the epicenter of the fight to end the record-long government shutdown that lasted from October 1 to November 12.

While Democrats in Congress have pushed for an extension of increased subsidies, a majority of Republicans have said they oppose it.

A group of 17 House Republicans voted with Democrats on Thursday to extend the subsidies. The measure faces lengthy disagreements in the GOP-controlled Senate, which rejected a three-year extension in December.

There is also Trump threatened to veto such a measure.