(The Center Square) – At a 22% decrease in enrollments to the Affordable Care Act, North Carolina is the national leader according to Centers for Medicare & Medicaid Services analysis by The Center Square.
About 214,000 fewer people enrolled in 2026, dropping the state to 761,457. The trend contrasts national numbers that are up more than 3.3 million to 22.9 million in all exchanges.
North Carolinians are registered through HealthCare.gov, an exchange with more than 2.5 million of the new consumers.
The 2010 Obama era law was centered in the shutdown of the federal government in October and November. When the 43-day impasse ended in November, the enhanced subsidies of the Affordable Care Act were not extended, and expiration came on Jan. 1.
That meant higher premium increases for many, in some cases doubling out of pocket costs. Critics pointing to failings of the system say taxpayers got a break in the hundreds of billions of dollars.
Health care is pivotal in American homes. The U.S. Census Bureau, in the latest numbers available released in September, said North Carolina’s poverty rate of 12.8% for 2023 was unchanged from the year prior. That means more than 1.3 million have income of less than $31,200 for a family of four, 17th highest of all states and the District of Columbia.
For the 2026 Affordable Care Act’s individual policies, third-term Republican state Insurance Commissioner Mike Causey in October approved rate increases between 16.88% and 36.4%, with an average of 28.6%.
“Increased costs in health care as well as the expiration of federal subsidies result in premiums going up for many on the individual market,” Causey said in acknowledgment.
As U.S. Rep. Dr. Greg Murphy, R-N.C., told it in November during the shutdown, taxpayers have been on the hook for more than $400 billion through expanded subsidies under an emergency or temporary basis tied to the Affordable Care Act. Benchmark premiums, he said, are up 75% since 2019.
“These were temporary measures put in by Democrats through the American Rescue Plan and the Inflation Reduction Act during COVID to supposedly help people get more health insurance,” Murphy said.
More than three years ago, on Aug. 15, 2022, then-Gov. Roy Cooper ended the state of emergency for COVID-19 in the state. Illinois, on May 11 the following year, was the last of the 11 states that still had one ongoing when North Carolina ceased.
“The enrollment of individuals that filed no claims during this entire period has shown us that anywhere from 6 to 12 million individuals are on these plans fraudulently,” Murphy said. “They haven’t enrolled. They haven’t made any claims whatsoever, and so basically, the checks are going from the federal government – your taxpayer dollars – are doing directly from the federal government to insurance companies and for their profit margin. That’s a huge number.”
