I’ve been checking on the progress of the Affordable Care Act’s open enrollment season, which is happening as Congress continues to debate whether to extend subsidies that gave consumers extra help paying their health insurance premiums.
The story has sparked reactions from readers who face significant cost increases if these enhanced subsidies end. They wrote about trying to find ways to cut hundreds of dollars a month from family budgets, or even facing the prospect of being uninsured — and thus unable to continue treatment for cancer or arthritis. A few said they were waiting to see if Congress would act, while others were enrolling but opting for less expensive plans with higher annual deductibles.
These cost increases could have serious political repercussions.
According to A KFF poll Released this month, about half of those currently registered to vote said that if overall health care expenses — copayments, deductibles and premiums — increased by $1,000 next year, it would have a “significant impact” on whether they vote in next year’s midterm elections or which party candidate they will support.
As for enrollment, the Centers for Medicare & Medicaid Services on Dec. 5 released early numbers showing 949,450 new sign-ups — people who didn’t have existing ACA coverage — across the federal and state markets. This is slightly lower than around the same time last year, when there were 987,869 new registrants. But CMS showed an increase in the number of returning customers who have already chosen a plan for next year, with the number up by more than 400,000 compared to the same time in 2024.
Jessica Altman, executive director of the California Insurance Market, and Audrey Morse-Gastere, executive director of the Massachusetts exchange, said it was too early to know how the final numbers would compare to 2025’s record 24 million sign-ups nationwide.
California reported a 33% decline in new registrations through December 6. More people are choosing “bronze” level plans, which feature lower premium payments than most other ACA plans but higher deductibles, Altman said.
The state’s two stock exchange directors said they are hearing from fearful consumers.
“Our call centers are receiving heartbreaking phone calls from people about not being able to understand how they can stay covered,” Gastier said.
If Congress acts, even in January, states say they can update their websites to reflect the changes, but those updates could take a week or two. Meanwhile, people who sign up for coverage will pay their premiums based on information originally programmed, which assumes benefits will end at the end of the year.