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Charles Gaba's blog

Grouching towards Enrollment: My 2026 ACA OEP Guide

Sun, 10/26/2025 - 2:29pm

Almost exactly a year ago I began my 2025 ACA Open Enrollment Period guide with the following words:

This is the best OEP ever for the ACA for several reasons:

  • The expanded/enhanced premium subsidies first introduced in 2021 via the American Rescue Plan, which make premiums more affordable for those who already qualified while expanding eligibility to millions who weren't previously eligible, are continuing through the end of 2025 via the Inflation Reduction Act;
  • A dozen states are either launching, continuing or expanding their own state-based subsidy programs to make ACA plans even more affordable for their enrollees;
  • 100,000 or more DACA recipients are finally eligible to enroll in ACA exchange plans & receive financial assistance!

What a difference a year can make.

  • Read more about Grouching towards Enrollment: My 2026 ACA OEP Guide
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Get Covered
2026 Open Enrollment

How much more will ACA enrollees have to pay if the enhanced subsidies expire? (updated)

Fri, 01/10/2025 - 8:57am

USE THE DROPDOWN MENU ABOVE TO PICK A STATE.

9/29/25: Welcome Paul Krugman subscribers! I greatly appreciate the shoutout by him but should add the following clarification:

Regarding the chart below which he reposted comparing the original ACA subsidy scale to the current version: You probably think that if the enhanced subsidies expire it will revert back to the original version, which would be bad enough. In fact, however, the Trump Regime has also made THAT version even worse, like so:

I should also note that I've started cross-posting key entries at Substack as well.

  • Read more about How much more will ACA enrollees have to pay if the enhanced subsidies expire? (updated)
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APTC
Kill the Cliff
Up the Subs
Subsidy Cliff
IRA

ACA Signups: 2025 Year in Review (Jan - Jun)

Tue, 12/30/2025 - 2:48pm

I originally launched ACASignups.net in the fall of 2013 during the first batcrap insane ACA Open Enrollment Period. That means it’s been around for over 12 years now.

Every week I send out a weekly digest, which pretty much just includes a roundup of links to everything I had published the previous week, regardless of how major or minor it was.

However, I’ve never published an annual roundup of the most significant things I wrote over the course of the year…until today.

I also wanted to thank all of my supporters, whether you’ve been following my work for years or just started to do so recently; it means a lot to me.

Speaking of which, if you find my work useful & would like to support it, you can do so in two ways:

  • Read more about ACA Signups: 2025 Year in Review (Jan - Jun)
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California: Covered CA reports 617K active enrollments, up 1.3% y/y so far...but a deeper look portends disaster for many...

Tue, 12/30/2025 - 10:16am

via Covered California's Open Enrollment Dashboard, as of December 27th:

  • New enrollments: 137,958
  • Active renewals: 479,358
  • Passive Autorenewals: 1,318,779
  • Total: 1,936,095

As I've noted before: While I include the passive/auto-renewal number for completeness sake, that number won't really be relevant until after the deadline for January 1st coverage passes (which isn't until New Year's Eve in California).

More important for the moment is the total number of active enrollments, which includes both new enrollees as well as current enrollees who log into their account and actively select a plan for 2026.

In California, those come to 617,316 combined.

As of the same point last year (actually 1 day more; the data from last year is as of 12/28), Covered CA was reporting:

  • Read more about California: Covered CA reports 617K active enrollments, up 1.3% y/y so far...but a deeper look portends disaster for many...
  • Comments
California
Covered California
2026 Open Enrollment
Get Covered

CMS posts claimed September 2025 Medicaid/CHIP enrollment report: 77.1M, down 2.4M since December 2024

Mon, 12/29/2025 - 4:52pm

The Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

September 2025 Key Findings

Medicaid and CHIP Enrollment

  • In September 2025, 77.1 million individuals were enrolled in Medicaid and CHIP.
  • 69.8 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 40.3 million adults were enrolled in Medicaid, and there were 36.7 million Medicaid child and CHIP enrollees.

Total Medicaid/CHIP enrollment in September 2025 of ~77.1 million dropped about 0.9% from July 2025, or by around 700,000 people.

  • Read more about CMS posts claimed September 2025 Medicaid/CHIP enrollment report: 77.1M, down 2.4M since December 2024
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CMS
Medicare
Medicaid
CHIP

Reminder: 2026 Open Enrollment isn't over yet! 10 states still have time for Jan. 1st coverage; 49 states still have time for Feb. 1st coverage!

Sun, 12/28/2025 - 11:07am
Magazine advertisement for the 1946 film Deadline at Dawn Date	March 1946 publication Source	Photoplay for March 1946, page 9 Author	RKO Pictures

Originally posted 12/19/25

Since we're past the initial December 15th Open Enrollment Deadline for coverage starting January 1st in most states and since there's been several enrollment deadline extensions announced by various states (including two more today), I figured this would be a good time to post a completely updated rundown of just what the remaining deadlines are for every state as well as what your options are if you miss them.

This is basically a standalone version of the first section of my annual Open Enrollment Guide; I hope that separating it out will make it less overwhelming.

IDAHO: December 15th was the only deadline for 2026 coverage. If you missed it, you're pretty much out of luck unless you qualify for one of the following exceptions:

  • Read more about Reminder: 2026 Open Enrollment isn't over yet! 10 states still have time for Jan. 1st coverage; 49 states still have time for Feb. 1st coverage!
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2026 Open Enrollment
Connecticut
Vermont
Washington State

"But how many have PAID?" Revisited: Enrollment drop-off won't be fully known for months

Fri, 12/26/2025 - 1:58pm

Long ago in a galaxy far, far away, during the first batcrap insane 2014 Open Enrollment Period, a common refrain from Republicans looking to attack the newly-ramping up healthcare law was to demand "BUT HOW MANY HAVE PAID???"

The gist of the attack on the ACA was that after the worst of the ugly technical problems experienced by HealthCare.Gov and many of the state-based exchange websites were resolved, there was indeed a rush of backed-up demand to enroll in healthcare coverage by millions of people, but that just because a lot of people signed up for insurance coverage via the exchanges, that didn't necessarily mean they were actually enrolled in that policy.

The reason for this, of course, is that you have to actually pay your first monthly premium in order to have your enrollment "effectuated" (i.e., put into effect).

  • Read more about "But how many have PAID?" Revisited: Enrollment drop-off won't be fully known for months
  • Comments
2026 Open Enrollment
Effectuated Enrollment
eAPTC
Tax Credits

California: Covered CA reports 584K active enrollments, up 2.8% y/y so far

Fri, 12/26/2025 - 11:28am

via Covered California's Open Enrollment Dashboard, as of December 20th:

  • New enrollments: 123,461
  • Active renewals: 460,670
  • Passive Autorenewals: 1,355,397
  • Total: 1,939,528

As I've noted before: While I include the passive/auto-renewal number for completeness sake, that number won't really be relevant until after the deadline for January 1st coverage passes (which was December 15th in most states, but not until 12/31 in CA, IL, MD, NV, NJ, NM, PA, RI & VA).

More important for the moment is the total number of active enrollments, which includes both new enrollees as well as current enrollees who log into their account and actively select a plan for 2026.

In California, those come to 584,131 combined. This also means that only 25% of current enrollees had actively re-enrolled as of 12/20.

As of the same point last year (actually 1 day more; the data from last year is as of 12/21), Covered CA was reporting:

  • Read more about California: Covered CA reports 584K active enrollments, up 2.8% y/y so far
  • Comments
California
Covered California
2026 Open Enrollment
Get Covered

CMS touts Nebraska being first to launch Big Ugly Bill Medicaid work reporting requirements by misspelling the name of the state.

Wed, 12/24/2025 - 4:08pm

As of March 2025, around 72,000 Nebraska residents were enrolled in Medicaid via the ACA's expansion of the program.

Last summer, after Congressional Republicans passed their Big Ugly Bill, I warned people against assuming that the gutting of Medicaid wouldn't hit until after the 2026 midterms:

Over at The New Republic, Greg Sargent has taken this thinking one step further, noting that by delaying so much of the ugliness of the new law until 2027 or beyond...

Republicans know how unpopular all this will be. So they’ve structured the bill so the tax cuts land immediately, while many of the Medicaid cuts get going in 2027 and 2028. That’s meant to spare them in the midterms.

  • Read more about CMS touts Nebraska being first to launch Big Ugly Bill Medicaid work reporting requirements by misspelling the name of the state.
  • Comments
Nebraska
Big Ugly BIll
Medicaid
Medicaid Expansion
Work Requirements

Dr. Oz announces 15.6M HC.gov enrollees to date, down 600K from last year...but no CMS report

Tue, 12/23/2025 - 5:09pm

Just before shutting down for Christmas, Trump Regime CMS Administrator Dr. Oz announced that...

Quick ACA Update: More than 15.6 million Americans have enrolled in a plan on the federally run exchanges so far — compared to roughly 16 million Americans last year.

Notably, this small drop follows several important CMS actions over the past year to combat fraudulent and improper enrollments, which have already removed more than enough people from premium subsidies who are covered elsewhere to account for the modest enrollment change. That said, there is a politically motivated lawsuit that has paused critical actions to make sure Biden-era improper enrollments are fully knocked out.

IMPORTANT NOTE: For those who need insurance and have not already signed up — go to HealthCare.Gov to see if you qualify and what types of plans you can get. Most Americans can access a plan for $21 a month!

  • Read more about Dr. Oz announces 15.6M HC.gov enrollees to date, down 600K from last year...but no CMS report
  • Comments
2026 Open Enrollment
Get Covered
CMS
Healthcare.Gov

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