ACA enrollment in WA plummets 13% after premium hikes

Thousands of Washingtonians have opted out of buying their own health insurance this year after monthly premiums spiked for middle-income households.

In 2026, approximately 250,000 Washington residents enrolled in a health plan through the Washington Health Benefit Exchange, which runs the state's Affordable Care Act marketplace. Compared with last year, that's a decrease of almost 13%, according to a new report published by the state exchange.

That translates to 36,500 fewer enrollees across the state - an unprecedented decline.

This is the sharpest drop we've seen since the exchange was established," said Tara Lee, chief communications officer for the Washington Health Benefit Exchange.

The exchange was launched in 2012 after the passage of the ACA in 2010. The law created a regulated system through which people can buy their own insurance if they don't get coverage through an employer or public programs.

During the COVID-19 pandemic, Congress introduced enhanced premium tax credits, a subsidy to help middle-income households afford insurance purchased through the exchange.

Those tax credits expired at the end of last year, despite concerted efforts by Democratic lawmakers to extend them, including a legislative standoff that resulted in the longest-ever government shutdown.

Enhanced premium tax credits helped enrollees save $1,330 per year in premiums on average, according to the state health exchange. The number was even higher for older adults between 55 and 64, who saved an estimated $1,910 per year.

As premiums surged, thousands of enrollees faced a difficult choice: Pay significantly more for health insurance or go uninsured.

The latest figures indicate that tens thousands of people across Washington have chosen the latter option.

"For every one of those people, that's not an easy decision to have to make," Lee said. "Nobody wants to go without health insurance."

Not every household that disenrolled is necessarily uninsured. Some people may have chosen to get coverage through an employer instead. That includes self-employed people who shut down their businesses in order to get a job with health benefits.

The latest figures represent a potential reversal of once-promising trends. Last year, ACA enrollment hit a record high. At this point in 2025, more than 286,000 people had enrolled and paid for coverage. The fraction of Washingtonians going without insurance was also falling.

"This is a crisis," wrote Sam Hatzenbeler, legislative director at the Economic Opportunity Institute, a progressive policy nonprofit in Washington, in a news release on Tuesday. "Health is fundamental. Without coverage, people get sicker, lose work, lose housing, and lose hope."

On the bright side, disenrollment fell short of the most dire predictions.

Last year, the state health exchange estimated that as many as 80,000 people would drop out of coverage due to higher premiums.

To cushion the blow, the state exchange designed its own plan to extend some financial relief for those who would no longer get enhanced premium tax credits, up to $250 per person per month.

That helped blunt disenrollment to some extent. "It could have been a lot worse," Lee said. "But it's still not great.

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