How much more are ~120,000 IDAHO 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 IDAHO:

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

Idaho is an interesting outlier: Not only is it one of a handful of states where year over year enrollment has increased, it's done so without any state subsidies, special programs or other mitigation policies in place that I'm aware of.

Furthermore, while enrollment in several income brackets has dropped (especially those just over 400% FPL, which makes sense given that those folks are no longer eligible for financial assistance), it's increased in quite a few others, including an extremely unusual 74% increase in enrollees below 100% of the Federal Poverty Level (FPL)!

This is very strange given that the Trump Regime eliminated federal subsidy eligibility to low income legally-residing immigrants who have been U.S. residents for less than 5 years. The actual numbers are small (from ~2,200 to ~3,900 enrollees), but it's very strange that the < 100% FPL enrollment went up at all. Huh.

Meanwhile, 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 dropped by about 2.6 points since last year:

IMPORTANT: I only have detailed CSR category enrollment data for the 30 states hosted via the federal ACA exchange, HealthCare.Gov. Unfortunately, the Centers for Medicare & Medicaid Services (CMS) only provides total CSR enrollment for most of the 21 state-based exchanges (SBEs).

For these states, which include Idaho, I'm instead relying on rough estimates based on the percent of enrollees in the 100 - 150%, 150 - 200% and 200 - 250% FPL income brackets who selected Silver plans each year, which can be found in the 2025 & 2026 OEP State, Metal Level, and Enrollment Status Public Use Files (ZIP) from CMS.

These percentages, when converted into raw numbers, correspond fairly closely to the actual CSR category breakouts for FFM states (+ or - 5%), so they should be close enough for my purposes. I've also come up with rough estimates for the AI/AN CSR category based on comparisons of the percent of AI/AN CSR QHPs selected in FFM states to the percent of AI/AN residents within each state. This is less than 3.3% in every SBE state except for New Mexico.

Again, these are broad estimates only but should be reasonably accurate for this project.

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 Idaho, the ~120,000 residents who signed up for ACA exchange coverage this year have seen their net premiums jump by 57% on average...along with a ~21% increase in out of pocket expenses.

Combined, on average, that's a 38% increase in total net healthcare costs, from ~$3,200 apiece last year to over $4,400 per enrollee in 2026.

That's over $1,200 more per enrollee this year than last.

In addition, based on KFF's net data, average deductibles also jumped by 20% to nearly $5,000 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: ILLINOIS.