The end of enhanced tax credits for Affordable Care Act health plans has led to a five percent decrease in the number of people who enrolled in ACA plans during the open enrollment period that ended on January 15.

 

According to federal data, about 23 million Americans signed up for such plans this year, down 1.1 million from last year – a significant decline, although not as great as predictions that enrollment could fall as much as 30 percent.

Because of the loss of the enhanced premiums tax credits, insurance premiums doubled for some applicants, putting them out of the financial reach of many.

In all, 41 states experienced declining ACA plan enrollment, including a 22 percent drop among North Carolinians and 20 percent among Ohio residents.  Meanwhile, nine state and the District of Columbia experienced increases, including an increase of 200,000 Texans.

It remains to be seen how many of those who signed up for plans will actually pay their premiums.

Members of Congress are currently negotiating the restoration of at least some of the enhanced premium tax credits.

Any reduction in the number of insured Americans has troubling implications for community safety-net hospitals, which serve areas with especially high proportions of low-income and working-class families that may soon find themselves without health insurance – but with medical needs for which they will still turn to community safety-net hospitals for help.

Learn more about 2026 ACA health plan enrollment from the Healthcare Dive article “ACA enrollment backslides to 23M in 2026” and this Centers for Medicare & Medicaid Services fact sheet on ACA enrollment for 2026.