Sign-ups for Affordable Care Act (ACA) health insurance have dropped by more than 800,000 compared to last year as the expiration of federal tax credits drives up monthly premiums, NBC News reported on Monday, citing state and federal data.
As the open enrollment period for 2026 concludes, the report indicates that Americans are increasingly dropping coverage entirely or shifting to cheaper, lower-tier plans. This trend follows the failure of Congress to extend enhanced tax credits for Obamacare customers, resulting in significant increases in monthly costs across the country.
Data from the Centers for Medicare & Medicaid Services (CMS), which manages HealthCare.gov for 30 states, shows a nationwide decrease in both new enrollees and renewals. In response to inquiries from NBC News, several state-run exchanges reported sharp increases in coverage drops.
State health officials in Idaho, Massachusetts, and Virginia told NBC News that roughly twice as many people have dropped coverage for 2026 compared to the same period last year. In Pennsylvania, coverage terminations have more than tripled, surpassing 70,000 enrollees.
Conversely, some states, including Colorado, Minnesota, and New Mexico, reported that overall sign-up figures remained flat or showed slight increases.
Shift to “Bronze” Plans
For those maintaining coverage, many are migrating to “bronze” plans, the lowest-tier option. While these plans offer lower monthly premiums, they often come with high deductibles that can discourage consumers from seeking care.
In California, state officials told NBC News that nearly three-quarters of renewing enrollees moved to bronze plans. Similarly, Kentucky health officials noted that approximately 15,000 enrollees changed plans, with the majority seeking more affordable options.
Sophie-Charlotte Bidet, a California resident, told NBC News her family’s premium was set to triple to $3,300 a month before she switched to a bronze plan. Despite the change, she still pays $2,800 monthly and recently decided to forgo an emergency room visit for her daughter due to fears over high out-of-pocket costs.
The health care landscape remains uncertain as the U.S. House of Representatives recently passed a bill to restore the enhanced subsidies for three years. However, the report noted that President Donald Trump suggested he might veto the three-year extension.
Health policy experts warn that the current sign-up data may not yet reflect the full scale of coverage losses. Cynthia Cox, a director at KFF, saidsign-up figures can be misleading because some individuals may select a plan but fail to make their first premium payment, leading to termination later in the spring.
“The worst is yet to come for the enrollment trend,” Kevin Patchett, director of Virginia’s Insurance Marketplace, said. Experts such as Larry Gostin of Georgetown University warned that the failure to extend subsidies could provoke a “national crisis,” particularly for rural hospitals that may face a surge in uninsured patients who cannot pay for care.