Decline in ACA Enrollment Highlights Challenges Post Subsidy Phase-Out

The enrollment of North Bay residents in Affordable Care Act (ACA) health plans saw a significant downturn, with a 33% decline in new participants following the federal subsidy phase-out. However, this was offset by a rise in renewals, resulting in a modest overall enrollment drop of only 2.3%.

New sign-ups in the area decreased from 10,862 last year to 7,331 this year, while renewals increased from 52,363 to 54,452. New enrollments encompass uninsured individuals enrolling in a Covered California plan for the first time or rejoining after more than a year's hiatus.

This trend reflects statewide data, with new enrollments dropping by 32% and total enrollment decreasing by 2.6%, as reported by Covered California. Jessica Altman, executive director of Covered California, emphasized that the cessation of pandemic-era Enhanced Premium Tax Credits posed a significant challenge, previously making health plans more affordable.

Altman remarked, “Many Californians see the value in remaining covered, but they had to make sacrifices and shift to lower-tier plans.” The enrollment window spanned from November 1, 2025, to January 31, 2026.

The removal of tax credits hit new enrollments across demographics hard, with Latino and Black residents seeing substantial drops at 39% and 34%, respectively. A growing preference for Bronze plans led over a third of new enrollees to choose this affordable option, up from less than a quarter previously. Statewide, more than 130,000 individuals opted for these plans.

To counter the loss of federal subsidies, the state will allocate $190 million from the Health Care Affordability Reserve Fund in 2026 to provide state-funded tax credits for those earning up to 165% of the federal poverty level. This initiative aims to keep premiums stable for qualifying individuals and families.

Covered California reported strong renewal numbers, attributed to the historic increase in 2025. Renewals statewide grew by 3.6% this year after a 10.5% increase between 2024 and 2025. While renewal rates among low-income consumers remained stable, middle-income groups earning around 400% of the federal poverty level faced a drastic 59% drop in new sign-ups and a 22% cancellation rate, the highest across all income brackets.

Most enrollees, approximately 935,700, are in Southern California, with an additional 20% residing in the Greater Bay Area.