"For now, the online marketplace for ACA health plans is pricing in rates without the subsidies. Open enrollment for coverage in 2026 began this month, with premiums more than doubling on average, according to KFF, a nonpartisan health policy research group. That's due to the ACA subsidies expiring and insurers hiking rates. In an Oct. 23 note, Oxford Economics senior U.S. economist Matthew Martin pointed out that more than half of the 24 million enrollees receiving these subsidies live in a handful of Southern states."
""Southern states have a much higher share because most of these states did not expand Medicaid coverage in 2010's ACA or 2021's American Rescue Plan Act despite federal support to do so," he wrote. Of the 10 states with the highest share of the population receiving Obamacare subsidies, eight are in the South and voted for President Donald Trump last year. They include Florida, Georgia, Texas, Mississippi, South Carolina, Alabama, Tennessee and North Carolina. The other two states in the top 10, Utah and Wyoming, are also Republican states."
Open enrollment for 2026 began with marketplaces pricing plans without ACA premium subsidies, and average premiums have more than doubled. The loss of subsidies stems from the decision not to renew federal payments and insurers raising rates. More than half of the roughly 24 million subsidy recipients live in a handful of Southern states that did not expand Medicaid, increasing reliance on marketplace subsidies. Ten states account for the highest shares of subsidy beneficiaries, eight of which are Southern Republican states. Expiration of subsidies would expose enrollees to full premium costs and reverse recent enrollment gains.
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