ACA marketplace enrollment is declining nationally and Congress is struggling to extend the expired subsidies.
Five updates on enhanced ACA subsidies:
1. President Donald Trump said Jan. 11 he might veto a bill to extend the subsidies, Bloomberg reported. The House voted Jan. 8 to extend the subsidies for three years, but the measure is not expected to pass in the Senate. A bipartisan group of senators is instead advancing a narrower two-year proposal that would include new income limits, minimum monthly premiums and additional guardrails around enrollment. Legislative text could be finalized as soon as this week, but no immediate relief is guaranteed for providers planning for 2026.
2. ACA marketplace enrollment dropped to 22.8 million for 2026, down 3.4% from the same time last year, according to CMS data published Jan. 12. New consumer sign-ups have fallen nearly 12%.
3. Individual states are also reporting major enrollment declines. In Pennsylvania, the state’s marketplace is losing roughly 1,000 enrollees daily. Illinois, Connecticut and Pennsylvania have extended their open enrollment deadlines.
4. A handful of states have taken action to mitigate the impact of the expired subsidies. For example, Massachusetts will invest an additional $250 million to help some residents pay for premium increases, and New Mexico’s marketplace has reached record enrollment after the state replaced the subsidies.
5. Hospital leaders are warning that the subsidies expiration will increase ED volumes and uncompensated care. A Commonwealth Fund analysis in 2025 projected a $57 billion drop in national economic output and the loss of 286,000 jobs, including 130,000 healthcare positions.
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