as Open enrollment for Affordable Care Act insurance ends, people switch to cheaper plans or drop coverage altogether, according to state and federal data.
Last year, Congress failed to extend the term enhanced tax credits For Obamacare customers. The result was this increasing monthly premiums across the United States
“People say, ‘I just can’t do the math.’ I can’t afford it. I just have to roll the dice and hope I don’t have any health problems this year,” he said.
NBC News reached out to 20 states that have implemented their own ACA exchanges, including Washington, DC. Registration for 2026. Ten state health officials responded with their latest numbers. In the 30 states that NBC did not ask for, people buy ACA insurance through HealthCare.gov, which is run by the Centers for Medicare and Medicaid Services.
The agency released information on Monday showing a national enrollment decline of more than 800,000 last year. Fewer new enrollees are signing up and fewer are renewing coverage.
In three states, Idaho, Massachusetts and Virginia, state health officials said nearly twice as many people will drop coverage by 2026 than at the same point last year. The number of terminations in Pennsylvania has more than tripled to more than 70,000 and is still rising.
Other states, California, Kentucky and New York, report new enrollments are down and more enrollees are switching to bronze plans, the lowest-tier option that comes with high deductibles. Three other states, Colorado, Minnesota and New Mexico, say total enrollments are flat or higher.
State officials and health policy experts caution that enrollment numbers do not necessarily reflect how many people will have health insurance this year. The open enrollment period ends on January 15 in most states, meaning people still have a chance to sign up.
State data also provide only a partial picture, and the federal government’s latest nationwide enrollment figures are still weeks away.
Cynthia Cox, director of the ACA program at KFF, a nonpartisan health policy research group, said that based on her research, “national enrollments appear to be down from last year, but apparently not as low as some might expect.”
It is possible that Congress could still pass a bill to restore the enhanced subsidies. Last week Ev adopted the bill on the extension of loans three more years and the Senate is preparing its own version.
President Donald Trump said Sunday he may veto the three-year extension.
Coverage losses to make matters worse
Some people who signed up for 2026 plans may never make their first premium payments, and insurers typically cancel unpaid plans weeks or months later — meaning the full extent of coverage losses may not be clear until late spring or summer.
“It’s kind of like the difference between putting something in your shopping cart and paying for it,” Cox said. “Registration data may indicate that more people are registered than actually are.”
Virginia state health officials said they are waiting more people must leave the coverage until March — when the grace period for people to make their first payment ends and insurers can end coverage.
“The worst is yet to come for enrollment trends,” said Kevin Patchett, director of the Virginia Insurance Market. “It will take another month or two before we see the effects.”
Idaho health officials expect more people to drop coverage by April.
Pat Kelly, executive director of Your Health Idaho, the state’s ACA marketplace, said there is an optional survey when people opt out. “We saw nearly three times as many consumers refer to this question as price-appropriate than we did in the same period last year,” he said.
Go for the cheaper option
Sophie-Charlotte Bidet, a contracted public defender in Mammoth Lakes, Calif., said her family’s health insurance premiums will triple to $3,300 a month after the enhanced tax credits expire.
Bidet went from a silver to a bronze plan for 2026, but he still had to find two side jobs to cover the $2,800 monthly expenses.
Now his family’s income is much higher than before. On Sunday, Bidet said her 10-year-old daughter, Juliet, hurt her wrist, but Bidet decided to go to the emergency room, fearing potential high out-of-pocket costs.
“It feels like a punch in the gut,” Bidet said.
California officials said about three-quarters of people who renewed ACA coverage switched to bronze plans. This year, more than a third of new enrollees chose bronze plans, up from 1 in 5 last year.
In Kentucky, Beth Fisher, deputy executive director of the public affairs office of the state’s Health and Family Services Cabinet, said about 15,000 enrollees have changed plans, with most switching to a “more affordable option.”
Morse Gasteier of Massachusetts said officials are seeing more middle-class people switch to cheaper plans.
Switching to cheaper plans or dropping coverage altogether could have ripple effects across the health care system.
“When you think about people who are uninsured or have fraudulent junk insurance, we know what happens to people,” Morse Gasteier said. “They’re delaying care. They’re getting worse. And they never touch the health care system. They’re still showing up in emergency rooms. They’re still showing up at the doors of hospitals and community health centers.”
Those patients still need care; hospitals cannot turn away people who cannot pay.
“Many hospitals, particularly in rural areas, will have to reduce services or close,” said Larry Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “Failure to extend ACA premium subsidies will cause a national crisis.”
