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ACA Enrollment Drops After Subsidy Expiration as Premiums Surge

Republican refusal to extend the aid triggered premium spikes that drove people off the exchanges.

Overview

  • After the enhanced Affordable Care Act subsidies ended at the close of 2025, premiums jumped and a Wall Street Journal–cited survey found nearly one in ten people with marketplace plans last year went uninsured.
  • Georgia’s marketplace sign-ups fell 37% to 950,000 by April 17, 2026, and for some residents premiums more than tripled once they had to pay full price above about $64,000 in income.
  • Republicans declined to renew the temporary subsidies and have not offered a broad replacement, while Trump’s TrumpRX site discounts only 43 drugs out of roughly 24,000 on the market.
  • Hospitals are expected to face more unpaid bills as coverage erodes, which can cut funds for equipment and staff and, over time, reduce the quality of care patients receive.
  • The ACA once drove big coverage gains in states like Georgia, Alabama, and Florida, yet several states still reject Medicaid expansion and Texas limits eligibility to 15% of the poverty level.