AZ ACA enrollment drops 65,000 as 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' 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 10 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."

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.