Overview
- CMS reports 22.8 million marketplace enrollments for 2026, roughly 1.2 million fewer than last year after the enhanced premium tax credits expired on Dec. 31.
- Consumers are buying cheaper plans with far higher deductibles or canceling coverage, with Maryland recording more than 16,000 tier changes and a sizable shift from gold to bronze plans.
- State data show notable declines, including about 120,000 fewer Ohio enrollees and roughly 51,000 fewer in Missouri, while several marketplaces report elevated cancellations tied to affordability.
- The Congressional Budget Office projects about 4 million people could become uninsured over time as costs outpace household budgets without the lapsed federal subsidies.
- Safety-net providers warn of rising uncompensated care and strained resources, and navigators report heavier demand even as federal funding cuts limit their capacity to assist consumers.