Dive Brief:
- Initial enrollment in Affordable Care Act plans has remained high despite uncertainty over whether more generous subsidies in the exchanges will continue next year.
- Some 5.8 million people signed up for ACA coverage in the first month of open enrollment for 2026, according to CMS data released on Friday. That’s ahead of the roughly 5.4 million signups at about this time last year for coverage in 2025.
- The early data seems to rebut worries that ACA enrollment will plummet next year if financial assistance that was expanded during the coronavirus pandemic is allowed to expire. Still, enrollment can shift over a signup period, and the data also suggests that fewer new enrollees are entering the exchanges than last year.
Dive Insight:
The ACA marketplace could look drastically different next year.
Republicans and Democrats have presented dueling health plans to curb the looming affordability crisis in the exchanges. Both are unlikely to pass, meaning subsidies that made ACA plans more affordable for middle-class families and free for more low-income Americans are almost certain to expire at the end of the year.
Premiums are set to double on average if that happens, while an estimated 4 million Americans will become uninsured — leaving the ACA exchanges sicker and smaller. The threat of that outcome has fueled calls from patient advocates, Democrat lawmakers, medical providers and health insurers to extend the subsidies for months. However, it doesn’t appear to be affecting enrollment, at least not yet.
The CMS data, which spans the first month of open enrollment, “does not present a doomsday scenario,” J.P. Morgan analyst John Stansel wrote in a note on Sunday.
But “it is early and CMS’s first [2025 open enrollment period] snapshot only represented ~25% of total sign-ups, so we think it is too early to conclude that 2026 may be better than feared,” Stansel continued.
Americans have just five more days to sign up for coverage that begins on Jan. 1. But there’s still more than a month until open enrollment officially ends — Jan. 15 is the last day consumers have to enroll in a health plan or change their election for the year.
As a result, there’s still time for the remaining roughly 17 million ACA enrollees who have yet to sign up for 2026 coverage to decide what to do. However, data suggests the most cost-conscious among them are unlikely to opt back in.
Roughly 1 in 4 ACA enrollees said they would go uninsured if their premiums doubled, according to a recent survey from health policy research group the KFF.
Congress has held numerous hearings and debated a bevy of proposals to curb the looming health cost spike, including a clean extension of enhanced subsidies in their current form. That’s uniformly supported by Democrats, which have argued that an extension can be phased out but will give Congress time to debate other ways to make healthcare more affordable.
However, Republicans are largely against an extension, citing the cost to taxpayers and incidences of subsidy fraud in the exchanges.
The Senate is set to vote this week on a Democrat bill that would extend the enhanced subsidies for three years at their current level. The body will also vote on a Republican bill from Sen. Bill Cassidy, R-La., to shift federal dollars into tax-advantaged savings accounts tied to high deductible ACA plans. Neither is expected to garner the 60 votes needed for passage.
Meanwhile, a concrete Republican proposal has yet to emerge in the House, though Speaker Mike Johnson, R-La., says he will soon unveil his own healthcare framework.
