The disappearance of Affordable Care Act (ACA) subsidies has left millions of households facing significant increases in health insurance costs. According to a report by the Centers for Medicare & Medicaid, there are 1.4 million fewer people enrolled in insurance through ACA marketplaces compared to January 2025. This decline is most pronounced in states such as Florida, Ohio, North Carolina, and Georgia, where enrollment has dropped by over 260,000 people. The majority of states have reported a decline in enrollment, with only a few states like Texas and California seeing an increase.
The enhanced ACA subsidies, which were passed in 2021 and expired on December 31, made health insurance more affordable for low- and middle-income Americans. Without these credits, Americans in the marketplace may see their out-of-pocket premium costs more than double compared to last year. This has left many households feeling health insurance sticker shock, with experts warning that people may have to choose between paying their health insurance premiums or skimping on other essential expenses.
The White House has attributed the decline in enrollment to efforts to remove people who were improperly enrolled on highly-subsidized ACA plans. However, experts argue that the lapse of ACA credits will have significant consequences for patients and hospitals. Matthew Fiedler, a senior fellow at The Brookings Institution, notes that people may have less access to care, leading to worse health outcomes, and that many households’ financial security is at risk.
Analysts expect a steeper decline in ACA enrollment over the next few months, as people may drop coverage once they start receiving bills. The latest data only captures the number of people who selected a marketplace plan during open enrollment or were automatically renewed for their existing ACA coverage, but does not account for those who may have paid their health insurance premiums. A recent Congressional Budget Office report estimates that nearly 4 million Americans will lose or drop insurance over the next decade.
The lapse of ACA credits may also put more pressure on hospitals, as providers could see an influx of uninsured patients, and people may be less likely to seek care in the first place. Experts warn that this could have significant consequences for the healthcare system, particularly for facilities that are already financially fragile. As the debate over healthcare continues, lawmakers must consider the impact of their decisions on millions of Americans who rely on the ACA for access to affordable healthcare.