Hello! I'm Julie Appleby, a senior correspondent at KFF Health News, where I cover all things health insurance. Send tips to jappleby@kff.org.
By Julie Appleby
It's February, so open enrollment for the Affordable Care Act is over. We're getting the first glimpses of how sign-ups are shaking out after the expiration of enhanced subsidies that helped most people with their premium costs.
While more Americans enrolled than some policy analysts had expected, the number was still 1.2 million below what it was at the same time last year. And experts say it will be months until the numbers are final. The timing will depend on how many of those people who signed up for coverage actually pay their premiums and remain enrolled.
In coming weeks, "consumers may find they really can't afford the premiums and cancel their plans, while carriers may also cancel coverage for nonpayment," said Pat Kelly, executive director of Your Health Idaho, a state-based ACA marketplace, during a Jan. 22 call with reporters.
The drop comes after several years of record-breaking enrollment, with 24.2 million sign-ups for the 2025 enrollment year. Enrollment growth took off after enhanced subsidies — which lowered the amount most households had to pay out of their own income toward premiums and removed an upper-income cap — went into effect during the Biden administration. Lawmakers, in adopting the enhanced subsidies, set an expiration date of Dec. 31, 2025.
Congressional debate over extending those more generous subsidies was heated, even leading to the longest-ever government shutdown. Now, the subsidies are back to their original level, and people who earn more than four times the federal poverty rate (about $62,600 for an individual or $84,600 for a couple) can't qualify for any at all.
Falling enrollment was seen in most states this year, with the biggest drop in North Carolina, where sign-ups fell by nearly 22%, federal data shows.
In a few places — including New Mexico, Texas, and Maryland, as well as the District of Columbia — the number of people selecting ACA plans increased.
The jump was largest in New Mexico, with its tally of people selecting plans up by nearly 18%. Increases were in the single digits in the other states and Washington, D.C.
New Mexico — uniquely — used its own tax dollars to fully offset the loss of the more generous federal tax subsidies for all consumers. A few other states, including California, Colorado, Maryland, and Washington, used state money to help some enrollees.
We'll keep watching to see how this unfolds over the coming weeks.
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