As federal subsidies disappeared this year, more than 30,000 Utahns chose not to get or renew Affordable Care Act health plans.
About 388,000 Utahns signed up for insurance through the ACA, also called Obamacare, for 2026, according to a Centers for Medicare & Medicaid Services factsheet. That’s an 8% drop from last year – and advocates for health care access expect the gap to expand.
“Folks are dropping off because they can’t afford the premiums,” said Matt Slonaker, executive director of the Utah Health Policy Project, a nonprofit organization that works to provide better access to health care.
Premiums jumped for many this year after more generous subsidies made available during President Joe Biden’s administration expired on Jan. 1.
Those subsidies expanded eligibility by lowering the percentage of household income people had to pay toward their care and reducing the income cap. The debate over whether to extend them led to the longest-ever government shutdown.
The Congressional Budget Office predicted that it would lead to millions losing insurance this year. The UHPP is already seeing that through its Take Care Utah program, which helps people get insurance.
“We had a number of clients who saw the new premium cost and basically hung up the phone,” said Daryl Herrschaft, who directs the program.
The subsidies made it possible for people making more than 400% of the federal poverty level — just over $62,000 for an individual — to qualify for Affordable Care Act tax credits and save hundreds each month. People estimate what they’ll earn in the coming year and get the subsidies up front.
Members of Utah’s congressional delegation did not immediately respond to requests for comment on lower enrollment numbers, but they have previously said they were willing to discuss an extension or gradual tapering down of the extended subsidies.
About 7% of Utahns enrolled in plans through the marketplace last year made enough that they qualify only for the enhanced subsidies, according to the Kem C. Gardner Policy Institute, a research institute based at the University of Utah.
People who responded to a recent survey from The Salt Lake Tribune said they saw massive jumps when those subsidies went away, including three Utahns whose premiums for themselves or their families tripled.
One couple will now pay $1,974 each month – about three times what they paid in 2025. Another couple will pay more than $1,000 each month – an increase of around $300 – for the lowest-tier plan with a high deductible.
Utah enrollment dropped more than the national rate
Based on CMS data, about 1.2 million fewer Americans signed up for plans through the marketplace this year than the 24.2 million who signed up for 2025.
Utah was one of 32 states where enrollment dropped by more than the national decrease of 4.9%.
Nineteen states saw a larger drop than Utah, and 16 – including neighboring Wyoming and Arizona – had double-digit percentage drops.
Enrollment did increase in 10 states, in some cases because states acted to offset the expiring subsidies.
New Mexico is using state tax dollars to offset the loss of the federal subsidies for all consumers. A few other states, including California, Colorado, Maryland and Washington, used state money to help some enrollees.
Slonaker said conversations with state lawmakers haven’t indicated that Utah would do the same.
Numbers likely to drop more
And the state’s numbers will likely get worse, he said, because many Utahns were automatically reenrolled in their existing marketplace plans.
“They’re not too worried about it because it worked last year,” Slonaker said, but they’ll get hit with a larger premium and likely will drop off and go without health insurance as a result.
People who qualified for the enhanced subsidies make too much to qualify for Medicaid, he said, and either can’t afford their employer-provided insurance or don’t have access to it. In Utah, only 40.8% of small businesses offer health insurance to their employees, according to the Gardner Institute.
And when people drop off health insurance, Slonaker said, it affects the broader system.
Costs are made up elsewhere, such as when hospitals charge additional fees to make up the gap, he said. Meanwhile, emergency department use often goes up because people aren’t getting regular medical care.
“We’re very worried that this is a major setback for all that Utah has gained in the last decade,” Slonaker said.