Overview
Amid rising costs and the expiration of enhanced subsidies, fewer North Carolina residents enrolled in health coverage under the Affordable Care Act for 2026, according to the latest figures from the Centers for Medicare & Medicaid Services.
What is ACA Coverage and why do people use it?
Signed into law in 2010 by then-President Barack Obama, the Affordable Care Act expanded health care coverage for millions of Americans.
The law created tax credits to help lower out-of-pocket costs. It also barred insurers from charging people with pre-existing health conditions higher premiums or denying coverage altogether.
Since its passage, the ACA, also known as Obamacare, has survived several legal challenges and attempts by Republican lawmakers to repeal it.
How many people enrolled in health coverage under the ACA in North Carolina for 2026?
Just 761,457 people enrolled in health coverage under the ACA in North Carolina for 2026, according to the latest figures from the Centers for Medicare & Medicaid Services. The decline is about 22%, or 214,000 fewer enrollments, than in 2025, the largest drop in the country.
Last year, more than 975,000 North Carolina residents, about 9% of the state’s total population, enrolled in coverage under the ACA.
Nationally, less than 23 million people enrolled in health coverage under the ACA for 2026, according to CMS data. In 2025, more than 24 million enrolled.
Why did fewer North Carolinians enroll in ACA coverage?
Increased premium costs and the expiration of enhanced subsidies led to the sharp decline in enrollment, according to healthcare experts and advocates.
In 2025, state Insurance Commissioner Mike Causey approved a nearly 30% average rate hike for ACA plans purchased through the federal marketplace, healthcare.gov. Causey said the increases were necessary due to rising healthcare costs and the One Big Beautiful Bill Act, which President Donald Trump signed into law in July.
Enhanced tax credits that went into effect during the pandemic expired at the end of the year. Those tax credits, which were at the center of the longest government shutdown in history, did two things to help individuals who needed health insurance coverage:
1. They increased the financial assistance ACA enrollees received when purchasing coverage on the Health Insurance Marketplace.
2. They expanded eligibility to people earning more than 400% of the federal poverty level.
Additionally, the federal government's steep cuts to the ACA navigator program, which educates consumers on marketplace coverage and other coverage options, likely led to fewer enrollments in North Carolina.
Nicholas Riggs, the director of the NC Navigator Consortium, a statewide network of health insurance navigators, told NC Local there was high demand for appointments with navigators during open enrollment given the cost increase and confusion around subsidies. Navigators even ran out of availability.
North Carolina lost a large portion of federal funding for navigator programming. Its grant award was cut by 90%, from more than $7.5 million to just $750,000.
“Our whole goal is to provide unbiased assistance for folks and help people explore the marketplace and provide high quality care and assistance for folks,” Riggs said. “When we're not able to do that, it's frustrating for all of us, especially for those that we serve.”
Will more people in North Carolina lose ACA coverage?
This year, most people are paying more for the same health care coverage, Riggs said, while many chose higher-deductible plans to lower their monthly premium. Others did not enroll in coverage at all, Riggs added.
Meanwhile, some consumers enrolled in hopes that Congress would ultimately extend the now-lapsed enhanced subsidies.
“Based on some of the conversations that we had, some folks are saying, ‘Well, I'm going to see what happens with the subsidies. If they're not extended, I don't know if I can pay this premium every month,’” Riggs said. “So, we expect that there will be a good number of folks who drop off after this month who just aren't able to pay their premiums.”
Earlier this year, there were talks to extend enhanced premium subsidies, but any momentum behind an extension appears to have waned.
Who is most affected?
Some professions rely more heavily on individual coverage, such as chiropractors, musicians, real estate agents, farmers and dentists, according to KFF. In each of these industries, at least one-fourth of professionals nationwide get their coverage through the individual market.
What are people who lost coverage doing?
It is unclear how people who lost coverage are coping, and few alternatives exist for people making too much money to qualify for Medicaid.
Some consumers are purchasing short-term policies which have coverage limitations and fewer protections. Others are seeking care through community health centers which treat patients regardless of ability to pay. Local health departments may also provide access to services for uninsured and underinsured people.
Some professional associations are providing plan options for their members. For example, NC Realtor, a trade association for thousands of realtors, offers Anthem health care plans for purchase by members. The NC Dental Society also offers plan options for members.
KFF Health News also recommends discussing financial options with your medical provider and looking for cost-saving measures on prescription drug expenses.
This article first appeared on NCLocal and is republished here under a Creative Commons Attribution-NonCommercial 4.0 International License.