State Policy · AL
Alabama ACA Enrollment Drops 23% After Enhanced Premium Tax Credits Expire
Alabama saw 95,000 people — 23% of total enrollment — drop Affordable Care Act marketplace coverage in 2026 after enhanced premium tax credits expired at the end of 2025. The tax credits, which lowered premiums and expanded eligibility to households earning above 400% of the federal poverty level, were not extended by Congress despite advocacy from Democrats during fall 2025 budget negotiations. Without the subsidies, premiums increased 58% on average nationally. The decline affects small business owners, multiple-job holders, and early retirees ineligible for Medicaid or employer coverage — including Alabamians in the Medicaid coverage gap, since Alabama has not expanded Medicaid.
Why it mattersIn non-expansion states like Alabama, ACA marketplace coverage is the only option for adults in the coverage gap — the loss of enhanced subsidies pushes this population toward uninsurance, increasing uncompensated care costs for safety-net providers and potentially driving future Medicaid enrollment if coverage becomes unavailable.