I'm keeping an eye on the progress of the Affordable Care Act's open enrollment season, which comes as Congress continues to debate whether to extend the subsidies that have given consumers additional help paying insurance premiums.
The story prompted responses from readers who faced significant cost increases if expanded subsidies expire. They wrote about trying to find ways to squeeze hundreds of dollars a month out of family budgets, or even the possibility of remaining uninsured and therefore unable to continue treatment for cancer or arthritis. Some said they were waiting to see if Congress would act, while others enrolled but chose less expensive plans with higher annual deductibles.
This increase in costs could have serious political consequences.
According to KFF survey In a report released this month, about half of current members registered to vote said that if their total health care costs — copays, deductibles and premiums — increased by $1,000 next year, it would have a “major impact” on whether they vote in next year's midterm elections or which party candidate they support.
On the enrollment front, the Centers for Medicare and Medicaid Services released preliminary data on Dec. 5 showing 949,450 new enrollments—people who did not have current ACA coverage—in federal and state markets. That's down slightly from about the same period last year, when 987,869 new members were registered. But CMS saw an increase in the number of returning customers who had already chosen a plan for next year, up more than 400,000 compared to the same period in 2024.
Jessica Altman, chief executive of the California insurance market, and Audrey Morse Gasteyer, chief executive of the Massachusetts exchange, said it was too early to tell how the final data would compare with the record 24 million 2025 enrollments nationwide.
California reported a 33% decline in new enrollments through December 6th. Altman said more people are choosing bronze-tier plans, which have lower premiums than most other ACA plans but higher deductibles.
Both state exchange directors said fearful consumers are contacting them.
“Our call centers are getting heartbreaking phone calls from people saying they can't figure out how they can stay in coverage,” Gasteyer said.
If Congress acts, even in January, states say they could update their websites to reflect the changes, but those updates could take a week or two. At the same time, people who signed up for coverage would pay their premiums based on the originally programmed information, which assumed that subsidies would expire at the end of the year.
