North Carolina ACA Signups Drop 22% as Expanded Subsidies Expire

Individual ACA signups in North Carolina for 2026 fell 22 percent from the prior year, a drop of more than 213,000 people that represented the largest percentage decline of any state. The decline followed the expiration of expanded subsidies at the end of 2025. Those subsidies, created by the American Rescue Plan Act, had doubled nationwide ACA enrollment to about 24 million.

Ross and Rebecca Tobiassen canceled their plan in December after their monthly premium rose from $130 to more than $550. The couple own and operate a small auto shop in Sugar Grove, North Carolina, and are its only employees. Ross Tobiassen, 47, is mostly blind in one eye after metal shards and a corneal infection in 2020.

Rebecca Tobiassen said the new cost made continued coverage untenable. "It makes no sense," she said. " The Tobiassens joined an ACA plan in 2014 and initially paid about $30 per month. They later switched from a silver plan to a bronze plan as premiums and deductibles rose.

Their two teenage daughters remain covered by Medicaid. Katie Alexander, who has assisted North Carolina and Tennessee residents with ACA enrollment since the program's launch, said nearly 100 of about 700 Pisgah Legal Services clients dropped coverage during the most recent open enrollment. Many others selected cheaper plans with less coverage.

5 million in 2026. ACA premiums and deductibles had increased steadily since 2022 before spiking for 2026 plans. Risha Gidwani and Cheryl Damberg published a study earlier in 2026 showing that most bronze plans would be unaffordable without subsidies for the average enrollee.

Gidwani noted that taxpayers would have faced an estimated $350 billion cost over the next decade to maintain the enhanced subsidies. After canceling coverage, the Tobiassens considered but rejected a faith-based healthcare organization option. They have set aside emergency savings and identified credit cards or family support as last resorts if medical costs arise.