December 2025

via CoverME, Maine's ACA exchange:

The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.  

Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2026. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin coverage. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.   

The deadline to select a plan for coverage beginning January 1, 2026 is December 15, 2025. Consumers who select a plan between December 16, 2025 and January 15, 2026 will have coverage beginning February 1, 2026. 

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:

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:

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:

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!

via Covered California:

Covered California is encouraging all uninsured Californians to sign up for health insurance by Dec. 31.

The open-enrollment period for 2026 ends on Jan. 31, but to have insurance in place for January, consumers need to enroll by the end of the year. Covered California’s over 1.9 million enrollees also have until Dec. 31 to make any changes to their coverage for next year.

It has been a unique open enrollment with the Enhanced Premium Tax Credits set to expire heading into 2026. Since their introduction in 2021, the enhanced assistance has helped double enrollment nationally under the Patient Protection and Affordable Care Act and by over 23 percent in California.

So far this open enrollment, 123,461 Californians have signed up for 2026 coverage as of Dec. 20, marking a 30 percent decrease over the same period last year.

The Centers for Medicare & Medicaid Services just published updated enrollment data for Medicare, adding September 2025 to the data archive.

Whether the data posted since January 20, 2025 is accurate or not, I can't say for certain, but at least they're updating it...and so far, at least, I don't see anything in their monthly reports which is setting off any obvious red flags.

In any event, according to the latest report, as of September 2025:

• Total Medicare beneficiaries are up to 69.36 million (up ~77K month over month)
• Traditional/FFM Medicare beneficiaries are at 33.79 million (flat m/m)
• Medicare Advantage beneficiaries reached 35.57 million (up ~77K m/m)
• 12.12 million Medicare enrollees (around 17.5% of the total) were "Dual Eligibles"...that is, enrolled in both Medicare and Medicaid.

The only number which seems odd is the 384K increase in Dual Eligibles...I'm not sure what to make of that.

Yesterday morning on CNN's "State of the Union," host Kasie Hunt talked to Oklahoma GOP Sen. James Lankford about the enhanced ACA tax credits which are currently scheduled to expire exactly 10 days from now.

This gets into the weeds a bit, so I'm breaking it into two separate posts; I'll be publishing the second part tomorrow.

The crux of the CNN appearance was Langford claiming that "Obamacare" (the Affordable Care Act...guys, he's been out of office for nearly 9 years now, let it go willya?) "caused prices to skyrocket in the marketplace" and that the expiration of the enhanced tax credits put into place in 2021 during the COVID pandemic is simply "exposing the real issues" within the ACA.

First of all, let's clear up this "they were only put in place due to the COVID pandemic" talking point which Republicans keep tossing around (the implication being that since the COVID pandemic is over, the subsidy upgrade should end as well).

Get it straight: Eliminating the 400% FPL subsidy cliff and beefing up the tax credit formula is something which Democrats always intended to do when they had the ability to do so.

via the Massachusetts Health Connector:

BOSTON—The Massachusetts Health Connector’s New Year deadline is looming, with residents without health coverage having until Dec. 23 to enroll in affordable, comprehensive health insurance that starts Jan. 1, 2026.

Most people who apply for health insurance through the Health Connector get help paying for their coverage through the ConnectorCare program. The Health Connector is the state’s health insurance Marketplace, the only place where residents can get help paying for their coverage, and where residents can be assured they are getting a comprehensive health plan they can count on and avoid the junk plans that lurk on search engines.

Three important news items out of Connecticut today:

First, via Access Health CT:

HARTFORD, Conn. (December 16, 2025) — Access Health CT (AHCT), Connecticut’s official health insurance marketplace, experienced intermittent website outages on Monday, December 15, 2025 that impacted customers who wanted to enroll by that date to have coverage starting January 1, 2026. The website has been fully restored and is now available for eligible Connecticut residents to enroll in coverage.

Me, 11 days ago:

...Assuming new enrollment continues to only lag slightly behind last year, there could be up to ~4 million new enrollees for 2026, which means total plan selections could potentially hit ~25 million...which would actually break last year's record of 24.3 million.

If this happens (or anything close to it), you can expect the following scenario to play out:

Welp. In a development which should surprise absolutely no one, GOP House Speaker Mike Johnson has announced that the bipartisan "Fitzpatrick Bill" which would include a 2-year extension of the enhanced ACA tax credits (albeit with significant caveats) won't be included in their healthcare bill vote this week after all.

Via Politico:

Speaker Mike Johnson confirmed Tuesday he will not allow a House vote this week to extend expiring Obamacare subsidies — a reversal from last week when a GOP leadership aide said the process “would allow” for an amendment vote.

“In the end, there was not an agreement,” Johnson told reporters, noting the divides in his conference over the subsidies.

In my annual ACA Open Enrollment Guide, the first piece of advice is always to make sure you don't miss the deadline to enroll in healthcare coverage for the upcoming year.

I then list the various deadlines for people to get covered in each state, which is December 15th in most states for coverage starting January 1st (in a handful of states the deadline for January 1st coverage is as late as New Year's Eve).

I always include the caveat, though, that if you do miss that deadline, you still have an extra month or so (January 15th in most states) to enroll for coverage starting February 1st. This means that at worst, you'll have to "go bare" for the month of January (and pray you don't get sick or injured for those 31 days) before your coverage kicks in.

HOWEVER, there's an exception to this: IDAHO.

In Idaho, residents only have until December 15th to enroll in ACA coverage for 2026, period.

With the Senate failing to pass either the Democrats bill to simply extend the enhanced tax credits by 3 more years or the Republicans bill to make everything worse yesterday, all eyes turn to the House, where something like a dozen different bills, some with bipartisan support, some not, have been thrown against the wall to see if anything might stick.

Now, it looks like one of them might actually get a floor vote next week...but only as an amendment to another healthcare bill package being pushed by GOP House leadership, which of course raises all sorts of red flags.

via Laura Weiss of Punchbowl News on Thursday:

NEWS: Speaker JOHNSON & House GOP leaders are leaning toward giving mods a FLOOR VOTE on a bill extending enhanced ACA subsidies next week

Vote would be on FITZPATRICK bill as an amendment toOP leadership's health package JOHNSON told huddle of mods on the floor earlier he'd support amendment vote & could do it WITHOUT adding abortion funding restrictions.

via the Washington HealthBenefit Exchange:

OLYMPIA, Wash. – Today, the Senate failed to pass either of two health care bills they voted on, one of which was to extend the enhanced premium tax credits. Washington Health Benefit Exchange released the following statement:

“We are deeply disappointed Congress failed to extend the enhanced premium tax credits (ePTCs). We know these tax credits have made a tremendous difference to Washingtonians. They have helped to make health insurance more affordable, and without them more people will be forced to go without coverage and increase the uninsured rate. We also know that many of our customers will be forced to make tough decisions to afford the increased costs.  

“While this extension was not successful, we are grateful to members of our state Congressional delegation for their leadership in fighting for Washingtonians and highlighting this very important issue and the focus on health care affordability. 

So, as expected, both the Senate Democrats bill to simply extend the enhanced ACA tax credits for 3 more years and the Senate Republican bill to make everything worse just failed to reach cloture (appropriately enough, they both received the exact same vote counts: 51-48).

Sen. Rand Paul voted against the GOP bill and 4 Republicans voting for the Democrat's bill, including Sen. Josh Hawley, Sen. Lisa Murkowski, Sen. Dan Sullivan & Sen. Susan Collins voting for it. I'm not sure who the missing vote in each was, not that it matters much now.

So, now what?

Well, the House may end up voting on one of their dozen or so bills they've been tossing around, but I wouldn't count on it, and even if one of them passes, it'd be almost certain to fail in the Senate.

With just 4 more days before the initial December 15th deadline to enroll for coverage starting in January, only a weeks' worth of legislative session days before the holiday break, and just 20 days before the enhanced subsidies actually expire on New Year's Eve, it's looking grim.

OK, I know I said I wasn't gonna do a deep dive into any more last-ditch GOP bills ahead of tomorrow's big Senate vote, but this one looks intriguing...but not just for the reasons you might think.

Earlier today, GOP Rep. Jen Kiggans & Democratic Rep. Josh Gottheimer introduced Yet Another short-term enhanced ACA tax credit extension bill...but this one has some very interesting twists.

Via Politico:

The mounting support for the legislation, offered by Reps. Jen Kiggans (R-Va.) and Josh Gottheimer (D-N.J.), comes as House GOP moderates expressed frustration in a conference meeting Wednesday morning over their leadership’s proposals to address spiking health insurance premiums — without dealing with the expiring tax credits.

via Covered California's Open Enrollment Dashboard, as of December 6th:

• New enrollments: 62,247
• Active renewals: 389,329
• Passive Autorenewals: 1,363,264
• Total: 1,814,840

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 is December 15th in most states, although not until 12/23 in MA & 12/31 in MD, NV, NJ, NM & RI).

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 451,576 combined. This also means that only 22% of current enrollees had actively re-enrolled as of 12/06.

As of the same point last year (actually 1 day more; the data from last year is as of 12/07), Covered CA was reporting:

via the Washington HealthBenefit Exchange:

Amid tax credit uncertainty, many Washingtonians are still finding their health insurance for 2026 through Washington Healthplanfinder

OLYMPIA, Wash. – During the first month of open enrollment for 2026, more than 268,000 Washingtonians used Washington Healthplanfinder to shop, compare and sign up for health and dental insurance. Even though enhanced premium tax credits for next year may not be extended through Congress, many customers can still find plans with state and federal savings.

Open enrollment is currently underway for 2026, people who sign up by Dec. 15 will have coverage that starts on Jan. 1.  Everyone who signs up between Dec. 16 and Jan. 15 will have plans that begin on Feb. 1. At wahealthplanfinder.org, Washingtonians can shop for themselves or find help from a trusted resource in their community. Premium savings may be available to help make monthly costs more affordable.

Hot on the heels of Republican Senators Bill Cassidy of Louisiana & Mike Crapo of Idaho presenting their so-called "Health Care Freedom for Patients Act" which would do almost nothing to actually help ACA enrollees while causing more harm to transgender individuals (of course) and undocumented immigrants (of course), at least two more "The clock is ticking, we have to come up with SOMETHING!" bills have been rolled out today by Congressional Republicans.

First up is this one from former centrist Democrat-turned-MAGA-Republican Congressman Jeff Van Drew of New Jersey (h/t Andrew Sprung for bringing it to my attention):

Washington, DC -Today, Congressman Van Drew joined a bipartisan coalition of House members calling for a short-term extension of the Affordable Care Act's (ACA) tax credits with targeted modifications of the system. The group also sent a letter to House and Senate leadership asking for a meeting to discuss a clear path forward for health insurance.

via the New Jersey Dept. of Banking & Insurance:

TRENTON — In a bulletin issued today, the New Jersey Department of Banking and Insurance issued guidance to insurance carriers on health insurance coverage for childhood immunizations.

The Department advises that, regardless of federal actions relating to the childhood immunization schedule, it expects carriers to provide coverage for childhood immunizations recommended by the New Jersey Department of Health, including for the hepatitis B vaccination series, in accordance with State law and without cost sharing or the imposition of additional barriers.

Originally posted 11/03/25

For nearly a year now, I've been writing about the upcoming expiration of the enhanced ACA premium tax credits (eAPTC) which have been in place for the past five years. They're currently scheduled to expire at the end of December, less than 2 months from today.

I spent most of the year posting projected estimates of how much more different households will have to pay.

More recently, as the actual 2026 premium rate filings have been published, I revised those estimates with more accurate data.

Over the past few weeks as the various ACA exchange websites brought their 2026 ACA window shopping live, I've started plugging in different household scenarios to see what actual, real world price hikes look like.

Throughout all of these examples, however, two things have remained consistent:

Just before the close of business for the week, the Centers for Medicare & Medicaid Services (CMS) published the first official 2026 Open Enrollment Period snapshot report:

The Centers for Medicare & Medicaid Services (CMS) reports that nearly 950,000 consumers who do not currently have health care coverage through plans in the individual market Marketplace have signed up for coverage in 2026, since the start of the Marketplace Open Enrollment Period (OEP) on November 1, 2025. Existing consumers are also returning to the Marketplace to actively renew their coverage, and anyone who does not actively renew will be automatically re-enrolled for 2026. Over 4.8 million existing consumers have already returned to the Marketplace to select a plan for 2026.

Definitions and details on the data in this report are included in the glossary.

As usual, I'll start out with the top line numbers, compared to the same point last year:

There are 43 U.S. House districts where the Republican nominee won by 15 points or less. Of those, one (WA-04) doesn't really count since there were 2 Republicans running in the general election (Washington State has "jungle primaries"). Four others were won by Donald Trump by between 16 - 20 points (AZ-08, CO-04, TX-15 & WI-08).

That leaves 38 GOP-held House seats where the Republican won by 15 pts or less and where either Kamala Harris won, or Donald Trump also won by 15 points or less. The table below breaks these out with both margins, while also listing my estimate of how many residents of each district are enrolled in ACA coverage.

(h/t Ballotpedia & The DownBallot)

There's a couple of important caveats to keep in mind here:

For 12 years now, one of the traditions of ACA Signups has been The Graph: A line graph tracking enrollment in ACA policies over the course of each Open Enrollment Period.

The original Graph from 2013-2014 looked quite different from more recent years, partly because I was attempting to track Medicaid/CHIP enrollment and other coverage categories at the same time, and partly because, frankly, I didn't really know what I was doing at the time.

Over the next few years I modified & improved both my methodology as well as the format, culminating in last year's 2025 Open Enrollment Period Graph, which featured the highest enrollment figures in the ACA's history: ~24.3 million Qualified Health Plan (QHP) enrollees, plus another ~1.8 million Basic Health Plan (BHP) enrollees in Minnesota, New York & Oregon specifically, for a grand total of just a hair over 26 million people.

For the 2026 Open Enrollment Period, however, actual hard enrollment data has been, shall we say, difficult to come by so far.

via MNsure, Minnesota's ACA exchange (email only for now):

Minnesota residents affected by the end of Strategic Limited Partners coverage can enroll in new health insurance through MNsure

ST. PAUL, Minn.—MNsure is opening a limited special enrollment period (SEP) for Minnesota residents who purchased insurance through Strategic Limited Partners offsite of the MNsure website. The SEP follows enforcement action by the Minnesota Department of Commerce.

Commerce found that Strategic Limited Partners, an unlicensed company, sold unauthorized and deceptive health coverage to Minnesotans through misleading ads. Under a consent order, Strategic Limited Partners must cease operations by December 31, 2025, notify customers of its exit, repay outstanding claims, and pay a civil penalty.

To protect affected consumers, MNsure is offering this limited SEP:

CoverME, Maine's ACA exchange, is the second state after New Mexico to publish official 2026 Open Enrollment data:

The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.  

Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2026. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin coverage. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.   

The deadline to select a plan for coverage beginning January 1, 2026 is December 15, 2025. Consumers who select a plan between December 16, 2025 and January 15, 2026 will have coverage beginning February 1, 2026. 

Earlier this afternoon I joined cancer survivor and healthcare reform advocate Laura Packard on her CareTalk podcast to discuss the upcoming expiration of the enhanced ACA tax credits and the Trump Regime's confusing, will-they-or-won't-they non-proposal to maybe, possibly extend them...with a bunch of major caveats attached. Tune in!