ACA Enrollment Drops In North Carolina

Due to rising costs and the end of enhanced subsidies, fewer residents in North Carolina signed up for health coverage under the Affordable Care Act for 2026, as reported by the latest data from the Centers for Medicare & Medicaid Services.

Understanding the Affordable Care Act

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The Affordable Care Act, signed into law in 2010 by President Barack Obama, expanded health care access for millions of Americans.

This law introduced tax credits to reduce out-of-pocket expenses. It also prohibited insurers from charging higher premiums or denying coverage to individuals with pre-existing health conditions.

Since its enactment, the ACA, commonly referred to as Obamacare, has faced numerous legal challenges and efforts by Republican lawmakers to repeal it.

Additionally, only 761,457 individuals enrolled in ACA health coverage in North Carolina for 2026, according to the latest data from the Centers for Medicare & Medicaid Services. This represents a decline of about 22 percent, or 214,000 fewer enrollments, compared to 2025, marking the largest percentage drop in the nation.

Last year, over 975,000 residents of North Carolina, which is about 9 percent of the state's total population, enrolled in ACA coverage.

On a national scale, fewer than 23 million people signed up for health coverage under the ACA for 2026, based on CMS data. In 2025, more than 24 million had enrolled.

What caused the decrease in ACA enrollment among North Carolinians?

Health care experts and advocates attribute the significant drop in enrollment to rising premium costs and the end of enhanced subsidies.

In 2025, state Insurance Commissioner Mike Causey approved an average rate increase of nearly 30 percent for ACA plans available through the federal marketplace, healthcare.gov. Causey stated that these increases were necessary due to escalating health care costs and the One Big Beautiful Bill Act, which President Donald Trump signed into law in July.