Arizona ACA enrollment plummets by 66,000 as premium tax credits expire

The number of Arizonans who signed up for coverage through the Affordable Care Act Marketplace this year plummeted by more than 60,000, and health care advocates are warning the gap in coverage will only increase and could lead to ballooning costs for taxpayers.

A new report from Protect Our Care, an organization that advocates for affordable health care, found that there were 65,881 fewer enrollments via the marketplace this year in the Grand Canyon State than there were in 2025.

That was part of a broader decline nationwide, attributed to the decision by Republicans in Congress to refuse to extend tax credits that helped millions afford health insurance. Across the country, more than a million people chose to forego coverage this year.

And the number of uninsured is set to increase in the next few months, as people are kicked off their plans or cancel their coverage rather than pay higher premiums. An estimated 15 million people will be uninsured by 2034, according to projections from the Center on Budget and Policy Priorities, a nonpartisan research institute.

Critics say enrollment rates have fallen because of President Donald Trump and the GOP-controlled Congress's decision to slash Medicaid funding and refusal to extend tax credits that helped millions afford health insurance, both of which spiked premium costs at a time when they were already expected to increase. Republicans in Congress succeeded in pushing through a budget that cut more than $880 billion from Medicaid over the next ten years and rejected pleas from Democrats and constituents alike to extend the funding for the premium tax credits, which expired on Dec. 31.

Legislation to renew the credits for at least three years won the approval of the U.S. House of Representatives on Jan. 8, but the Senate has yet to take it up.

During a virtual news conference calling for the renewal of the tax credits, Steve Gallardo, a Maricopa County Supervisor who represents the county's southwest region, said he had increasingly met with constituents who have been forced to discontinue their health care coverage because of the unaffordable premiums. He warned that children have the most to lose and said the costs of a highly uninsured population will ultimately be borne by everyone else.

"When a family does not have the preventative care that they need in order to keep their families healthy, they end up in the emergency room," he said. "Who pays for that uncompensated care? It's taxpayers, people in the state of Arizona — with higher premiums."

Robert Hess III noted that health care coverage is not optional for people with chronic conditions. Hess depends on medication to stabilize his kidneys after a strep throat infection nearly caused him to go into kidney failure more than a decade ago, when he was unable to afford health insurance and tried to let the infection run its course. Because of the increase in premium costs, however, he was forced to enroll in a lower tier plan this year and has seen the quality of the care he receives decline.

Hess added that his brother-in-law, who was recently diagnosed with stage four metastatic cancer, saw a dramatic increase in premium costs without the help of tax credits, putting his family's ability to care for him at risk.

"When the clock struck 12 on January 1, 2026, their marketplace plan for their family increased over $600 a month," he said.

Hess urged Congress to restore premium tax credits and shore up health care funding, saying that it's of the utmost importance for Americans dealing with complicated health conditions as well as people who may face unexpected emergencies in the future.

"We critically need the Affordable Care Act," he said. "It is the care that people depend on, both for their chronic conditions, as well as the big scary stuff that nobody anticipates and those diagnoses that nobody ever wants to see. But when those things become unaffordable, families really have their backs up against the wall."

Health care affordability is top of mind for voters going into the November midterms. A January poll by the Kaiser Family Foundation, a health research organization, found that 66% of Americans rank concern over the cost of health care coverage above the costs of groceries, utilities, housing and gas. And 55% of Americans surveyed said the cost of their health insurance plans have increased.