The Affordable Care Act open enrollment window closed Thursday for plans starting in February in most of the country, setting a deadline for millions who rely on the health law’s marketplaces rather than employer coverage. The timing comes as the expiration of federal COVID-era expanded subsidies has pushed premiums higher and as lawmakers continue to debate whether to resurrect the tax credits that have helped many enrollees afford coverage.
The federal deadline also lands against a backdrop of uncertainty and slower sign-ups. Federal data cited by the Associated Press put enrollment at about 22.8 million people signed up so far, after a record 24 million Americans purchased ACA plans last year, according to the report.
Most states’ enrollment window ends Thursday, but the AP reported that about 10 states with their own marketplace marketplaces have later deadlines or have extended enrollment into the end of the month to give residents more time. The AP said the final-day date is especially important for small business owners, gig workers, farmers, ranchers, and others who buy health coverage on their own.
For many people, the uncertainty is tied to how much their coverage will cost without the expanded subsidies. The AP said the subsidies expired Jan. 1, leaving, according to KFF analysis, the average subsidized enrollee facing more than double the monthly premium costs for 2026.
The legislation debate over the subsidies has also dragged into the enrollment period. The AP reported that Democrats pushed a record-long federal government shutdown over the issue but still did not get a deal, and that the same uncertainty has continued to affect decisions on whether to sign up, with some enrollees telling the Associated Press they either delayed signing up for coverage or signed up with a plan to cancel as they watched Capitol Hill.
In the House, the AP said the chamber last week passed a three-year extension of the subsidies after 17 Republicans joined Democrats against the wishes of Republican leaders. But the AP said a similar bill failed in the Senate last year, leaving the path forward open to negotiations aimed at a compromise.
Sen. Bernie Moreno, an Ohio Republican, led a bipartisan group of 12 senators attempting to craft a proposal, and the AP reported that he expects a plan by the end of the month. The AP said the outlines under discussion include a two-year deal to extend enhanced subsidies while adding new limits on who can receive them.
The proposal described by the AP would also create an option, in the second year, for a new health savings account, a structure President Donald Trump and Republicans prefer. Under the deal being discussed, the AP said the ACA open enrollment period would be extended to March 1 to give more time to decide after disruptions.
Even with the negotiations underway, the AP said Republicans and Democrats have not completed the plan. The report said the two sides have not yet agreed on whether there should be new limits on whether states can use separate funds for abortion coverage, leaving another major issue unresolved as enrollment closes in most states.
The AP also reported that on Thursday, Trump announced outlines of a plan he wants Congress to consider. The AP said the proposal would redirect ACA subsidies into health savings accounts that go directly to consumers, which Democrats have largely rebuffed as inadequate to offset health costs for most people.