More people appear to be walking away from Affordable Care Act coverage or switching to cheaper plans for 2026 compared to this time last year, according to early enrollment data from several states.
State health officials in New York, Pennsylvania, Idaho, Colorado and California shared numbers from the first month of ACA open enrollment, which began Nov. 1 and runs through Jan. 15 in most states. Idaho opened two weeks earlier.
It’s too early to know whether the trend will hold, the officials said, noting that some people don’t finalize their plans until the final days of open enrollment — Dec. 15 for those who want their coverage to start Jan. 1. But the preliminary numbers could reflect signs of financial strain for people who can’t afford to pay hundreds of dollars more in monthly premiums once enhanced federal subsidies expire at the end of the year.
Those concerns likely deepened Thursday after the Senate voted against a Democratic bill that would’ve extended the subsidies for another three years, making it unlikely the tax credits will continue in 2026. Without them, millions of people are expected to face double-digit premium increases.
“There’s a lot yet to be seen, but there are definitely some early warning signs in terms of the decisions consumers are having to make in reaction to the changing federal policy,” said Jessica Altman, executive director of Covered California, a state-based marketplace for ACA coverage.
Last week, the Centers for Medicare and Medicaid Services released data showing nationwide sign-ups are running moderately higher compared to last year. Experts caution that early snapshots — both state and federal — may not offer the full picture.
Ellen Montz, the former deputy administrator and director at the Center for Consumer Information and Insurance Oversight at CMS, said there’s even more uncertainty over the data this year because many people may be waiting to see what happens with the enhanced subsidies before finalizing their coverage decisions.
People may also be worried about higher premiums and are logging in earlier to shop for cheaper plans, she said.
“This open enrollment is unlike any we have ever experienced,” Montz said in an email. “In typical years we would caution against making conclusions on total enrollment from the first few weeks of data and this year that caution is even greater.”
Nearly 5.8 million people have selected an ACA plan in the first 29 days of open enrollment, according to the CMS data, up almost 400,000 compared to this time last year. About 4.8 million people have renewed their coverage.
Early state warnings
In Pennsylvania — where monthly premiums are projected to rise more than 100% next year — sign-ups for first time ACA enrollees is pacing about 20% lower compared to the last two years, according to Devon Trolley, executive director of Pennie, the state’s health insurance marketplace.
She said the number of people who have dropped coverage has more than doubled the total from last year’s entire open enrollment period — about 40,000 people so far this year, compared to 19,000 last year.
Overall, about 30,000 fewer people have signed up for ACA coverage compared to last year.
“I think there’s just a lot of uncertainty about what to do, given the ongoing discussions federally,” Trolley said. “I think some people are ending their coverage and might come back, if the enhanced tax credits are extended.”
In Idaho, which began its open enrollment Oct. 15, state health officials are seeing a shift from gold and silver plans to bronze, which offer lower monthly premiums but a higher deductible.
Selections of bronze plans are up about 5% compared to this time last year, said Pat Kelly, executive director of Your Health Idaho, the state’s ACA marketplace. Most of that shift — about 4.5 percentage points — is coming from silver plans, and 1 percentage point is coming from gold.
“That increase in bronze is a strong indicator of affordability concerns,” he said.
People are also dropping their coverage, Kelly said. Calls to cancel plans are mentioning affordability about three times more often than they did at this point last year. About 25,000 Idahoans are expected to drop coverage by the end of open enrollment.
But Kelly added that most of the people dropping coverage are being replaced by new sign-ups, although he said it’s still unclear what’s driving that pattern.
Trolley said she’s worried some people are signing up now because they don’t want to go without coverage, only to drop their plans in the coming months when they realize they can’t afford them.
“We could see pretty big drop-offs in February and March because people try to pay their premium but realize they can’t,” she said.
Montz, the former CMS official, said a clear picture of enrollment may not emerge until HealthCare.gov automatically renews people’s plans Dec. 15, and people have several weeks to decide whether to cancel those renewals.
“When those numbers are eventually reported by the administration, I would expect that we will see disenrollments much larger than we have ever seen,” she said.
Coverage is too expensive
In New York, enrollment is trending down roughly 8% compared to this time last year, said Danielle Holahan, executive director of New York State of Health.
The state hasn’t yet parsed the data on people dropping coverage or switching to cheaper plans, although Holahan said they are seeing more people not renewing their coverage.
A large share of New Yorkers, she added, are already enrolled in bronze plans. New York officials are hoping enrollment picks up as the Dec. 15 deadline approaches.
“We’re seeing a lot of volume to our website and our call center, where people are shopping and looking to see what their plan options are,” Holahan said, “and, we suspect, experiencing sticker shock.”
Altman, of Covered California, said enrollment is significantly down, more than 30% lower compared to this time last year.
“They’re looking at their options and they’re saying it’s too expensive,” she said.
State officials are also seeing a “heavy movement” to bronze plans, with more than a third of new ACA enrollees choosing bronze, compared to about 1 in 5 last year, she said.
People are also dropping coverage: about 74,000 cancellations so far, compared to 68,000 at this point last year. But Altman said that number is still “pretty level” and will likely stabilize as the state moves closer to the end of open enrollment.
Colorado is seeing lower enrollment as well, running about 5% below this time last year, said Nina Schwartz, chief policy and external affairs officer at Connect for Health Colorado, the state’s ACA marketplace.
“Some customers who previously were enrolled in a plan in the Gold or Silver metal tiers are selecting plans in the Bronze metal tier for Plan Year 2026,” she said in an email.
This article was originally published on NBCNews.com
