3 Million Drop Health Coverage as Federal Subsidies End

Why it matters locally: The expiration of enhanced federal subsidies for health insurance is likely impacting North Carolinians who purchased coverage through the federal marketplace. Many in the state may now face higher premium costs, potentially leading to a similar decline in enrollment statewide as seen nationally.

Roughly 3 million people terminated their health insurance coverage through the federal marketplace following the Jan. 1 expiration of enhanced federal subsidies, according to preliminary data from enrollment tracking. The 13 percent enrollment decline prompted competing explanations from government officials and outside analysts about the underlying cause. The Department of Health and Human Services cited a crackdown on fraudulent enrollments as a contributing factor to the drop. The agency has intensified verification procedures and eligibility reviews over the past year. Health policy analysts, including those at policy research organizations tracking marketplace trends, attributed the enrollment decline more directly to the end of the temporary subsidy expansion. That program had reduced out-of-pocket premium costs for millions of enrollees since 2021. When the enhanced subsidies expired, the standard subsidy structure returned, increasing costs for households earning above 150 percent of the federal poverty level. Marketplace rules tie premium subsidies to income thresholds. Families earning more than 400 percent of the federal poverty level receive no subsidies under the standard framework. The Congressional Budget Office estimated in prior analyses that subsidy levels significantly influence enrollment decisions. Former enrollees cited affordability concerns in preliminary exit surveys conducted by marketplace administrators. State health officials reported increased calls from consumers questioning whether they could maintain coverage at the higher rates. The timing of the decline closely followed the Jan. 1 deadline when special enrollment periods ended and the standard subsidy rules took effect. The HHS data does not break down the enrollment loss by reason for cancellation. Marketplace enrollment had climbed to 16.6 million people during the period of enhanced subsidies. Current enrollment stands at approximately 13.6 million across federal and state marketplaces. Congress has not yet voted on legislation to extend the enhanced subsidies. Lawmakers continue to debate potential extensions or modifications to the subsidy structure ahead of the 2024 budget cycle.