How much more are ~23,000 HAWAII ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Today I'm looking at HAWAII:

Before I get into the cost side, let's take a look at what Hawaii's ACA exchange enrollment looks like by household income level this year vs. last.

As expected, enrollment below the federal poverty level (FPL) has dropped off a cliff, due mostly to the Trump Regime eliminating federal subsidy eligibility to low income legally-residing immigrants who have been U.S. residents for less than 5 years, along with some other categories of documented immigrants. Enrollment just over 100% FPL has actually increased; this is likely partly due to U.S. citizens who normally have incomes slightly under that threshold doing whatever they can to nudge their household income over 100% in order to qualify for the subsidies which remain. Note: The high percentage changes for both of these are a bit misleading as we're talking about just a few hundred people either way.

Enrollment at other income brackets has also dropped.

OK, onto the main analysis: Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by raw metal level...

...and now with Silver plans further broken out by CSR category, which is important since Cost Sharing Reduction (CSR) assistance boosts Silver plans up to Platinum levels of AV for most CSR enrollees. When I adjust for that, the weighted average AV increases in both years...but it has actually dropped by about 3.1 points since last year:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

In Hawaii, the ~23,000 who did sign up for ACA exchange coverage have seen their net premiums jump by 48% on average...along with a similar ~27% increase in out of pocket expenses.

Combined, on average, that's a 40% increase in total net healthcare costs, from ~$5,000 apiece last year to over $6,900 per enrollee in 2026.

That's nearly $2,000 more per enrollee this year than last.

In addition, based on KFF's net data, average deductibles also jumped by 36% to nearly $3,800 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: IDAHO.