It seems more and more people are leaving Affordable Care Act coverage or switching to cheaper plans in 2026 compared to last year, according to early enrollment data in several states.
State health officials in New York, Pennsylvania, Idaho, Colorado and California shared numbers for 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 tell whether the trend will continue, officials said, noting that some people are not finalizing their plans until the last days of open enrollment – Dec. 15 for those who want coverage to begin Jan. 1. But the preliminary figures may show signs of financial strain for people who cannot afford pay hundreds of dollars more in monthly insurance premiums once the expanded federal subsidies expire at the end of the year.
Those concerns were likely to intensify on Thursday after Senate voted against A Democratic bill that would extend the subsidies for three more years, making it unlikely that the tax breaks will continue into 2026. Without them, millions of people are expected to face double-digit premium increase.
“Much remains to be seen, but there are definitely some early signs in terms of the decisions consumers are having to make in response to changing federal policies,” said Jessica Altman, executive director of Covered California, the state's ACA coverage marketplace.
Last week The Centers for Medicare and Medicaid Services released data showing that registrations across the country are moderately higher compared to last year. Experts warn that the first snapshots – at both the state and federal levels – may not tell the full story.
Ellen Montz, former deputy administrator and director of the Center for Consumer Information and Insurance Oversight at CMS, said there is even more uncertainty about the data this year because many people may be waiting to see what happens with expanded subsidies before making final decisions about coverage.
People may also be concerned about higher premiums and are logging in earlier to buy cheaper plans, she said.
“This open enrollment is unlike any we have ever experienced,” Montz said in an email. “In normal years, we would be cautious about drawing conclusions about total enrollment based on data in the first few weeks, and that caution is even greater this year.”
Nearly 5.8 million people chose an ACA plan in the first 29 days of open enrollment, up nearly 400,000 from last year, according to CMS. About 4.8 million people renewed their insurance.
Early government warnings
In Pennsylvania, where monthly premiums are projected to rise more than 100% next year, first-time ACA enrollment is down about 20% from the previous two years, according to Devon Trolley, chief executive of Pennie, the state's health insurance marketplace.
She said the number of people dropping coverage was more than double the total during last year's open enrollment period — about 40,000 people this year, up from 19,000 last year.
Overall, about 30,000 fewer people signed up for ACA insurance compared to last year.
“I think there is a lot of uncertainty about what to do given the ongoing discussions at the federal level,” Trolli said. “I think some people are dropping their coverage and may return if the expanded tax breaks are extended.”
In Idaho, where open enrollment began Oct. 15, state health officials are seeing a shift from gold and silver plans to bronze plans, which offer lower monthly premiums but a higher deductible.
Selection of bronze plans is up about 5% from last year, said Pat Kelly, executive director of Your Health Idaho, the state's ACA marketplace. Most of this shift—about 4.5 percentage points—is in silver plans, while 1 percentage point is in gold.
“This increase in bronze is a clear indicator of affordability issues,” he said.
People are also turning away from lighting, Kelly said. Calls to cancel plans mention affordability about three times more often than last year. About 25,000 Idahoans are expected to drop insurance by the end of open enrollment.
But Kelly added that most people dropping coverage are being replaced by new subscribers, although he said it's still unclear what's driving that pattern.
Trolley said she's concerned that some people are signing up now because they don't want to go without coverage, only to cancel their plans in the coming months when they realize they can't afford them.
“We could see some pretty big reductions in February and March because people are trying to pay their premiums and realizing they can’t,” she said.
Montz, the former CMS official, said a clear picture about enrollment may not emerge until HealthCare.gov automatically renews people's plans on Dec. 15, and people have several weeks to decide whether to cancel those renewals.
“When the administration eventually reports these numbers, I expect we will see much more attrition than ever before,” she said.
Coverage is too expensive
In New York, enrollment is down about 8% from last year, said Danielle Holahan, executive director of the New York State Health Authority.
The state has not yet analyzed data on people dropping coverage or switching to cheaper plans, although Holahan said they are seeing more people not renewing their coverage.
She added that a significant portion of New Yorkers are already enrolled in bronze plans. New York officials hope enrollment will increase as the Dec. 15 deadline approaches.
“We're seeing a lot of traffic on our website and in our call center where people are shopping and seeing what their plan options are,” Holahan said, “and, we suspect, experiencing price shock.”
Altman of Covered California said enrollment is down significantly, more than 30% lower than last year.
“They're looking at their options and saying it's too expensive,” she said.
State officials are also seeing a “strong movement” toward bronze plans, with more than a third of new ACA enrollees choosing bronze, up from about 1 in 5 last year, she said.
People are also cutting back on insurance coverage, with about 74,000 cancellations happening so far, compared with 68,000 last year. But Altman said the number is still “fairly level” and will likely stabilize as the state approaches the end of open enrollment.
Colorado is also seeing declining enrollment, about 5% lower than last year, said Nina Schwartz, director of policy and external affairs for Connect for Health Colorado, the state's ACA marketplace.
“Some customers who were previously enrolled in a Gold or Silver metal tier plan are opting into Bronze metal tier plans for plan year 2026,” she said in an email.
