North Carolina ACA Sign-Ups Drop 22 Percent as Temporary Enhanced Subsidies End

North Carolina recorded the largest percentage drop in Affordable Care Act sign-ups of any state for 2026 coverage after Congress let enhanced federal tax credits expire at the end of 2025. Individual enrollments fell 22 percent from the prior year, a decline of more than 213,000 people, according to enrollment data.

Ross and Rebecca Tobiassen of Sugar Grove canceled their policy in December when their monthly premiums were scheduled to rise from $130 to more than $550.

"It makes no sense," Rebecca Tobiassen said. The couple own and operate the only employees of a small auto shop west of Appalachian State University. The Tobiassens had carried ACA coverage since 2014.

In 2020, Ross Tobiassen, now 47, became mostly blind in one eye after repeated metal shards caused a corneal infection. He said the condition does not affect his work. The couple's two teenage daughters remain covered by Medicaid.

5 million in 2026. Enrollment had doubled to about 24 million after the enhanced subsidies took effect under the American Rescue Plan Act. Katie Alexander of Pisgah Legal Services said nearly 100 of roughly 700 clients her team assisted during open enrollment dropped coverage for 2026.

Many others selected cheaper plans with reduced benefits. Alexander said the clients include Lyft and Uber drivers, artists, and people working part time because of chronic illness. KFF data showed ACA premiums and deductibles spiked during the 2026 open enrollment period after rising steadily since 2022.

The Tobiassens had switched from a silver plan to a bronze plan in prior years to manage costs. Their prior coverage had not paid for cornea-replacement surgery that would have cost up to $30,000 and required six months off work; Ross instead chose a less expensive nerve-killing procedure.