Rising healthcare costs drive record Obamacare enrollment declines in North Carolina

Coverage costs hit home

Health insurance decisions can change fast when a monthly bill suddenly jumps. In North Carolina, thousands of families faced that choice during the 2026 ACA enrollment period.

Rising premiums and the end of enhanced federal tax credits pushed many people away from marketplace plans, creating the steepest enrollment decline reported by any state this year.

North Carolina saw the largest drop

North Carolina’s ACA enrollment fell about 22% for 2026 coverage, according to marketplace data reviewed by health policy researchers and state health reporters this year during open enrollment.

That drop equals more than 213,000 fewer sign-ups compared with the year before. The decline stood out nationally because no other state posted a larger percentage decrease.

Enhanced subsidies expired

Enhanced premium tax credits helped many ACA customers pay lower monthly premiums from 2021 through 2025. Congress allowed those extra subsidies to expire at the end of 2025.

When that support disappeared, many families saw their monthly costs rise sharply. Some shoppers kept coverage, while others canceled plans or chose not to enroll at all.

A mountain family shows the strain

Ross and Rebecca Tobiassen, who run a small auto shop in western North Carolina, had used ACA coverage since the marketplace began in 2014.

They canceled coverage after Rebecca saw their monthly premium rise from about $130 to more than $550. Their two teenage daughters remained covered through Medicaid during the change.

Higher rates added pressure

North Carolina’s insurance department approved an average 28.6% increase for individual ACA plans in 2026, with some plan increases higher than that for consumers this year.

Those increases came before many families felt the loss of enhanced subsidies. Together, the two changes made coverage harder to afford for self-employed workers and small business owners.

National enrollment also fell

The coverage drop was not limited to North Carolina. KFF said ACA marketplace enrollment fell from 22.1 million people in 2025 to 19.2 million in February 2026.

That 13% national drop followed the expiration of enhanced premium tax credits. Analysts said the data showed more than planned selections because it measured people who paid premiums.

Bronze plans gained attention

Many shoppers tried to control monthly premiums by moving into bronze plans during open enrollment. These plans usually cost less each month but often carry higher deductibles.

KFF found bronze plan selection rose in 2026, while silver plan selection fell to a record low share. That shift can leave enrollees paying more when care is needed.

Deductibles became a bigger burden

KFF found the average ACA marketplace deductible rose by more than $1,000 per person in 2026, reaching about $3,786 across marketplace plans for many consumers.

That matters because a lower premium does not always mean affordable care. Families may still delay appointments, tests, or treatment when deductibles are difficult to meet during the year.

Little-known fact: Only two counties in western North Carolina saw increases in Affordable Care Act enrollment in 2026, while nearly every other county declined.

Some workers lack other options

ACA plans often serve people who do not get affordable insurance through work and do not qualify for Medicare or Medicaid programs in their state, North Carolina.

That group can include gig workers, artists, part-time workers, small business owners, and people between jobs. When marketplace coverage gets too expensive, many have few backup choices.

Local helpers noticed the change

Pisgah Legal Services helps people in western North Carolina and Tennessee compare marketplace plans. Staff said they had not seen a year like this before across the region.

Nearly 100 of about 700 clients helped during open enrollment decided to drop insurance, according to the report. Many others chose cheaper plans with less coverage in 2026.

Risk pools could feel the effects

When healthier people leave an insurance market, the remaining pool can become more expensive because fewer low-cost members help balance claims from sicker enrollees over future years.

Health researchers warn that this pattern can push premiums higher later. That cycle may make coverage harder for people who need regular care and stay insured through the marketplace.

The policy debate is not simple

Restoring enhanced subsidies would lower premium bills for many ACA customers, but it would also increase federal spending over future years.

Letting the enhanced credits expire reduces federal costs but raises premium bills for many households buying coverage on their own. That tradeoff keeps the ACA debate active in Congress and state health discussions.

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The coverage question remains

North Carolina’s enrollment decline shows how quickly health coverage can shift when premiums rise and subsidies change. For many families, affordability became the deciding factor in 2026.

The next test is whether people who dropped coverage return, find other options, or remain uninsured while policymakers weigh costs, subsidies, and the future of ACA marketplace plans.

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What do you think rising healthcare costs mean for Obamacare enrollment in North Carolina? Share your thoughts in the comments.

This slideshow was made with AI assistance and human editing.

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