ACA enrollment in North Carolina plummets after subsidies expire
Add Axios as your preferred source to
see more of our stories on Google.
The number of North Carolinians enrolled in health insurance plans through the Affordable Care Act has fallen significantly this year.
- More than 200,000 fewer people are getting insurance via the program this year, according to data compiled by KFF.
Why it matters: The drop came after enhanced subsidies for the ACA expired, making plans more expensive for many people.
- Across the country, initial sign-ups through the ACA have fallen by more than a million, the New York Times reported. But the number will likely be much higher by the end of the year.
Zoom in: North Carolina saw one of the biggest drops year-over-year, according to an analysis by Health Care Dive.
- In 2025, a little more than 975,000 people in the state got insurance through the ACA. This year's initial sign-ups put the number at around 761,000 — a 22% drop.
What they're saying: Nicholas Riggs, the director of the NC Navigator Consortium, which helps people sign up for ACA plans, said the drop was driven primarily by rising costs due to the expiration of pandemic-era enhanced subsidies.
- "We had a lot of folks tell us that they just could not afford a plan this year," Riggs told Axios. "There are folks who are choosing to go without coverage and that's always our concern," he added.
- A survey by KFF found that around 9% of people who were enrolled in ACA plans in 2025 are now uninsured.
State of play: Enhanced subsidies for the ACA were added during the pandemic in 2021 and expired at the end of last year.
- The subsidies became a centerpiece of the government shutdown fight that happened in Congress last year.
In 2024, North Carolina expanded eligibility for Medicaid in the state, which extended it to more than 600,000 North Carolinians.
- Some of the decline in ACA enrollment could be attributed to clients switching to Medicaid, Riggs said. However, he believes affordability was the main reason.
- He noted that between 2024 and 2025, the drop in ACA enrollment was much smaller at roughly 53,000 people.
The big picture: It's not just ACA enrollees facing sticker shock. Premiums have risen for many people, including workers who have insurance coverage through their employer.
- Around 64% of U.S. adults are worried about being able to pay for their health care costs, according to a poll by KFF, and the issue is likely to be weighing on many voters in this year's midterm.