A dramatic drop in ACA enrollment in NC spells trouble for Republicans | Opinion
Deputy Opinion Editor Paige Masten is covering the 2026 election for The Charlotte Observer and the Raleigh News & Observer.
Republicans’ decision to make health care more expensive for millions of Americans has had a very predictable effect: fewer people are choosing to enroll in insurance plans they can no longer afford.
In North Carolina, enrollment in Affordable Care Act plans is down 22% for the 2026 enrollment period, numbers released by the Centers for Medicare & Medicaid Services show.
More than 975,000 North Carolinians enrolled in an ACA marketplace plan in 2025 — nearly 9% of the state’s population. About 91% of those enrollees received the enhanced tax credits for their ACA coverage, which helped lower premiums. In 2026, the number of North Carolinians who enrolled in a plan fell to 755,919.
That’s the biggest enrollment decrease of any state, an analysis found.
Congress had an opportunity to extend the subsidies but failed to do so before enrollment ended. Earlier this month, 17 House Republicans joined Democrats in voting for a three-year extension of the subsidies, but the Senate has failed to reach its own deal. Notably, the GOP defections did not include any representatives from North Carolina, despite a recent push by Democrats to target two congressional districts they believe are flippable in the 2026 midterms.
Democrats have their sights set on North Carolina’s 3rd and 11th congressional districts, currently held by U.S. Reps. Greg Murphy and Chuck Edwards, respectively. After the House’s vote, a DCCC spokesperson called it “another cruel reminder that Chuck Edwards and Greg Murphy don’t care about North Carolinians struggling to keep up with skyrocketing health care bills and are instead actively working to raise costs.”
On average, out-of-pocket premiums double without the subsidies, but the exact increase depends on factors like age, location and income level. Older people living in more rural parts of North Carolina are among those seeing the biggest premium spikes. In Murphy’s district in eastern North Carolina, for example, premiums were predicted to rise by 457% for a 60-year-old couple making $85,000 per year, an analysis shows. In Edwards’ district in western North Carolina, that increase was predicted to be 403%.
But as the recent data shows, the fallout is more than just increased premiums. It’s also resulted in more people going without coverage at all. Experts warn that the decline in enrollment could grow even bigger, because more people could lose or drop coverage after their first insurance bill arrives.
That’s bad news for Republicans, who are deeply vulnerable on health care already. In North Carolina, voters ranked health care as the highest priority for their next senator in a recent poll, and concerns about affordability and the economy in general have bogged down the president’s approval rating in the state. Perhaps that’s why moderate and swing-state Republicans are reportedly pressuring Senate Majority Leader John Thune to bring legislation to the floor that would address the issue.
Health care should never be a privilege or a luxury, but any increase in the uninsured rate is bad for everyone. It leads to worse health outcomes for communities. It places more financial strain on providers, particularly in rural areas where hospitals are already floundering. Uninsured people will still need health care, especially in emergencies, but when they cannot pay for it, the costs are shifted onto everyone else. That’s the reality that Republicans have created. But is it really the one they want?
This story was originally published January 28, 2026 at 5:00 AM with the headline "A dramatic drop in ACA enrollment in NC spells trouble for Republicans | Opinion."
