NORTH CAROLINA — Individual Affordable Care Act (ACA) sign-ups in North Carolina for 2026 decreased by 22% compared with the previous year, a reduction of more than 213,000 people. The decline follows Congress allowing enhanced tax credits for ACA insurance plans to expire at the end of 2025.

Affordable Care Act premiums and deductibles increased starting in 2022 and saw a spike during the enrollment period for 2026 plans, according to data analyzed by KFF. Rebecca Tobiassen, who relied on ACA subsidized health insurance with her husband from 2014 until December 2025, stated that their monthly premiums increased from $130 to more than $550. She added, "It makes no sense. It's not worth it anymore."

An early analysis by KFF citing Wakely Consulting Group research indicated ACA enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026. Risha Gidwani, a healthcare policy researcher at the University of Colorado Anschutz School of Medicine, stated, "Plans are unaffordable, no matter how you cut it. It's just who is shouldering the unaffordability." Gidwani and Cheryl Damberg published a study this year that found most bronze ACA plans would be unaffordable without subsidies for the average person.

Risha Gidwani stated that if healthier individuals leave the risk pool, fewer people subsidize those who become ill, leading to increased premiums. She added, "That becomes what we call a death spiral." The Tobiassens have no plans to return to the ACA marketplace after dropping their coverage. Tobiassen stated that the couple has set aside money for a medical emergency and may rely on credit cards or family members if savings are depleted.