As open enrollment for Affordable Care Act insurance comes to an end, people are moving to cheaper plans or dropping their coverage entirely, according to state and federal data.<\/p>\n\n\n\n
Last year, Congress failed to extend enhanced tax credits for Obamacare customers. The result was soaring monthly premiums across the U.S.<\/p>\n\n\n\n
\u201cPeople are saying: \u2018I just can\u2019t make the math work. I cannot afford this. I\u2019m going to just have to roll the dice and hope I don\u2019t have any health issues this year,\u2019\u201d said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, the state\u2019s ACA marketplace.<\/p>\n\n\n\n
NBC News reached out to the 20 states, plus Washington, D.C., that run their own ACA exchanges about changes in sign-ups for 2026. Ten state health officials responded with their latest numbers. In the 30 states that NBC did not ask, people purchase their ACA insurance through HealthCare.gov, run by the Centers for Medicare & Medicaid Services.<\/p>\n\n\n\n
On Monday, the agency released data showing that nationally, sign-ups are down more than 800,000 from last year. Fewer new enrollees are signing up and fewer people are renewing their coverage.<\/p>\n\n\n\n
In three states, Idaho, Massachusetts and Virginia, state health officials say roughly twice as many people have dropped their coverage for 2026 compared with the same point last year. In Pennsylvania, terminations have more than tripled, to above 70,000, officials say, and are still growing.<\/p>\n\n\n\n
Other states, California, Kentucky and New York, report that new sign-ups are down and that more enrollees are shifting to bronze plans, the lowest-tier option, which come with high deductibles. Three other states, Colorado, Minnesota and New Mexico, say overall sign-ups are flat or higher.<\/p>\n\n\n\n
State officials and health policy experts caution that the sign-up totals do not necessarily reflect how many people will ultimately have health insurance this year. The open enrollment period ends Jan. 15 in most states, meaning there is still a chance for people to sign up.<\/p>\n\n\n\n
State data also offers only a partial picture, and final nationwide enrollment figures from the federal government are still likely to be weeks away.<\/p>\n\n\n\n
Cynthia Cox, director of the program on the ACA at KFF, a nonpartisan health policy research group, said that based on her research, \u201cit sounds like national sign-ups are down from last year, but on the surface they don\u2019t seem to be down as much as some had expected.\u201d<\/p>\n\n\n\n
It\u2019s possible that Congress could still pass a bill to restore the enhanced subsidies. Last week, the House passed a bill to extend the credits three more years, and the Senate is drafting its own separate version.<\/p>\n\n\n\n
President Donald Trump said Sunday, however, that he might veto the legislation on the three-year extension.<\/p>\n\n\n\n
Coverage losses to get worse<\/strong><\/strong><\/p>\n\n\n\n Some people who signed up for 2026 plans may never make their first premium payments, and insurers typically terminate unpaid plans weeks or months later \u2014 meaning the full scope of coverage losses may not become clear until late spring or summer.<\/p>\n\n\n\n \u201cIt\u2019s kind of like the difference between putting something in your shopping cart and paying for it,\u201d Cox said. \u201cThe sign-up data could make it look like more people are enrolled than actually are.\u201d<\/p>\n\n\n\n State health officials in Virginia said they expect more people to drop their coverage through March \u2014 when the grace period for people to make their first payments ends and insurers can terminate coverage.<\/p>\n\n\n\n \u201cThe worst is yet to come for the enrollment trend,\u201d said Kevin Patchett, the director of Virginia\u2019s Insurance Marketplace. \u201cIt\u2019s going to be another month or two before we see the impacts.\u201d<\/p>\n\n\n\n Idaho health officials expect more people to drop coverage through April.<\/p>\n\n\n\n Pat Kelly, executive director of Your Health Idaho, the state\u2019s ACA marketplace, said there is an optional questionnaire when people disenroll. \u201cWe saw about three times as many consumers citing affordability on that question than we saw over the same period last year,\u201d he said.<\/p>\n\n\n\n Moving to a cheaper option<\/strong><\/strong><\/p>\n\n\n\n Sophie-Charlotte Bidet, a contract public defender in Mammoth Lakes, California, said her family\u2019s health insurance premium was going to triple to $3,300 a month after the enhanced tax credits expired.<\/p>\n\n\n\n Bidet switched from a silver to a bronze plan for 2026, but she still had to pick up two additional jobs to help cover the monthly cost of $2,800.<\/p>\n\n\n\n Now, her family\u2019s deductible is far higher than before. On Sunday, Bidet said, her 10-year-old daughter, Juliet, hurt her wrist, but Bidet decided to forgo going to the emergency room over fear about the potential high out-of-pocket cost.<\/p>\n\n\n\n \u201cIt feels like a punch in the gut,\u201d Bidet said.<\/p>\n\n\n\n California officials said that nearly three-quarters of people renewing their ACA coverage moved to bronze plans. More than a third of new enrollees this year have selected bronze plans, compared with 1 in 5 last year.<\/p>\n\n\n\n In Kentucky, Beth Fisher, deputy executive director in the public affairs office in the state\u2019s Cabinet for Health and Family Services, said nearly 15,000 enrollees changed plans, with the majority moving to a \u201cmore affordable option.\u201d<\/p>\n\n\n\n Morse Gasteier, of Massachusetts, said officials are seeing more people in the middle class move to less expensive plans.<\/p>\n\n\n\n The shift toward cheaper plans or dropping coverage altogether can have ramifications that reverberate through the health care system.<\/p>\n\n\n\n \u201cWhen we think about people who are uninsured or who have bogus junk insurance, we know what happens to people,\u201d Morse Gasteier said. \u201cThey put off care. Their health conditions worsen. And it\u2019s not as if they never end up touching the health care system. They still do show up in the emergency rooms. They still do show up at the doors of hospitals and community health centers.\u201d<\/p>\n\n\n\n Those patients still need care; hospitals cannot turn away people who cannot pay.<\/p>\n\n\n\n \u201cMany hospitals, especially in rural areas, will have to reduce services or close,\u201d said Larry Gostin, director of the O\u2019Neill Institute for National and Global Health Law at Georgetown University. \u201cThe failure to extend ACA premium subsidies is going to provoke a national crisis.\u201d<\/p>\n\n\n\n