2小时前 发布于2026年1月28日，美国东部时间晚上10:29 / CNN政治
作者：[塔米·卢比]
帕特里克·西森/美联社
根据周三公布的联邦数据，2026年选择奥巴马医改（Affordable Care Act，即《平价医疗法案》）保险的人数减少了逾百万。这一下降发生在联邦增强型保费补贴到期之后，导致许多参保人的月付款金额大幅飙升。
据医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）数据，2026年选择医保计划的人数略低于2300万。相比之下，去年同期这一数字约为2420万。数据涵盖了30个使用联邦医保交易所的州的所有参保登记，这些州的开放 enrollment（参保登记）已于1月15日结束。但该数据未涵盖所有自行运营医保交易所的州的全部参保情况，其中有几个州允许人们在本月底前继续登记参保。
然而，专家表示，未来几个月总参保人数可能会进一步下降。相当一部分消费者被自动重新纳入原有保险计划，但可能要等到收到第一笔账单时才会意识到保费会大幅上涨。这可能促使他们放弃保险或根本不支付保费，从而在4月份被注销参保资格。
保护我们的医疗（Protect Our Care）——一个倡导组织——主席莱斯利·达赫（Leslie Dach）在一份声明中说：”这个数字并不能说明全部情况。随着人们发现自己负担不起医疗费用并停止支付保费，这些数字每个月都会大幅下降。”
健康政策研究组织KFF的奥巴马医改项目主任辛西娅·考克斯（Cynthia Cox）表示，由于增强型保费补贴的取消，继续参保的人可能要面对更高的保费或更高的免赔额。根据KFF的数据，今年保费预计平均上涨114%。
国会预算办公室（Congressional Budget Office）预计，由于更为慷慨的联邦补贴终止，今年奥巴马医改参保人数将减少200万。
增强型补贴是拜登政府在2021年《新冠疫情救济法案》中制定的，但已于2025年底到期。这项额外援助曾大幅推动奥巴马医改参保人数激增，特别是低收入美国人，他们可以获得保费为零或极低的保险计划。增强型补贴也使中产阶级参保人更容易负担保费，而这些人此前不符合补贴资格。
补贴终止引发了国会山激烈的党派之争，导致去年秋季出现创纪录的长期政府停摆。民主党坚持将联邦政府资金拨付与延长补贴挂钩，但最终在停摆持续期间让步。上个月，众议院在几名共和党议员与民主党人共同投票后通过了一项为期三年的补贴延长法案，但由于共和党强烈反对，该法案在参议院未能推进。
2026年参保人数的下降是自2020年以来首次出现下降。2020年有1140万人选择了医保计划。在唐纳德·特朗普总统第一任期内，参保人数逐渐下滑。
参保人数减少的具体情况
特别是新客户对2026年奥巴马医改政策的兴趣下降。新参保人数略低于340万，较去年同期下降14%。续保客户人数略低于1960万，下降了3%。
总体参保人数下降最显著的州包括北卡罗来纳州（下降22%）和俄亥俄州（下降20%），考克斯表示。但最大的增幅出现在新墨西哥州（增长14%）和哥伦比亚特区（增长9%）。
几个自行运营医保交易所的州，由于更多人取消了今年的保险计划，参保人数出现下降。
在科罗拉多州，截至该州参保登记期结束时，选择医保计划的人数略超过27.7万，较去年下降2%。新增参保人数下降了近四分之一。尽管该州推出了自己的保费援助计划以取代增强型联邦补贴，但这一举措仍未扭转下滑趋势。
科罗拉多州医保交易所（Connect for Health Colorado）首席执行官凯文·帕特森（Kevin Patterson）在一份新闻稿中表示：”一方面，看到参保人数相对稳定，仅略有下降，并且有这么多人获得了有意义的经济援助，这是令人鼓舞的。另一方面，创纪录数量的人因为根本负担不起月付款，或被迫在医疗保健与住房、食品等基本生活必需品之间做出选择而取消计划，这令人深感不安。”
Obamacare enrollment drops after enhanced premium subsidies expire
2 hr ago PUBLISHED Jan 28, 2026, 10:29 PM ET / CNN Politics
By [Tami Luhby]
Fewer people picked Obamacare coverage for 2026.
Patrick Sison/AP
More than a million fewer people have signed up for Affordable Care Act coverage for 2026, according to federal data released Wednesday. The drop comes after the expiration of the enhanced federal premium subsidies caused monthly payments to skyrocket for many enrollees.
Just under 23 million people selected plans for 2026, according to the Centers for Medicare and Medicaid Services. That compares to just under 24.2 million people in roughly the same period last year. The data includes all sign ups in the 30 states using the federal exchange, where open enrollment ended January 15. But it doesn’t capture full enrollment in all the states that run their own exchanges, a few of which are allowing people to sign up through the end of this month.
However, total enrollment is likely to fall in coming months, experts said. A sizeable share of consumers were automatically reenrolled in policies and may not realize how much their premiums will rise until they get their first bill. This may prompt them to drop coverage or simply not pay, which will result in their being disenrolled in April.
“That number does not tell the full story. These numbers are going to go dramatically down month after month as people decide that they can’t afford health care and stop paying their premiums,” Leslie Dach, chair of Protect Our Care, an advocacy group, said in a statement.
Those who keep their coverage are likely contending with higher premium payments or higher deductibles due to the lapsing of the enhanced premium subsides, said Cynthia Cox, director of the Program on the ACA at KFF, a health policy research group. Premium payments are expected to climb by 114%, on average, this year, according to KFF.
The Congressional Budget Office projected that 2 million fewer people would have Obamacare coverage this year due to the ending of the more generous federal subsidies.
The enhanced assistance was enacted by the Biden administration as part of a 2021 Covid-19 relief package, but it expired at the end of 2025. The additional aid had spurred a large spike in Obamacare enrollment, particularly among low-income Americans who could get policies with no or very low premiums. The enhanced subsidies also made coverage more affordable for middle-class enrollees, who previously didn’t qualify for help.
The lapsing of the subsidies sparked a fierce partisan battle on Capitol Hill that led to a record-long government shutdown last fall. Democrats insisted on tying funding the federal government to extending the subsidies but eventually relented as the shutdown dragged on. The House last month passed a three-year subsidy extension after several Republican lawmakers voted with the Democrats, but the legislation has been unable to advance in the Senate amid stiff opposition from the GOP.
The decline in sign ups for 2026 is the first drop since 2020, when 11.4 million people picked plans. Enrollment gradually slid throughout President Donald Trump’s first term.
Fewer enrollees
Interest in Obamacare policies for 2026 fell among new customers in particular. Just under 3.4 million new consumers signed up for policies, down 14% from a year earlier. Returning customers numbered just under 19.6 million, a decline of 3%.
The largest drops in overall signups include North Carolina, with a 22% plunge, and Ohio, with a 20% decline, Cox said. But the biggest increases were in New Mexico, where plan selections soared 14%, and the District of Columbia, with a 9% jump.
Several states that run their own exchanges saw their enrollment dip as a larger number of people canceled their plans for this year.
In Colorado, just over 277,000 people selected policies by the end of the state’s enrollment period, down 2% from last year. The number of new enrollees slid by nearly a quarter. This comes even as the state enacted its own premium assistance program to help replace the enhanced federal subsidies.
“On one hand, it’s encouraging to see enrollment remain relatively steady, with only a slight dip, and to see so many people receive meaningful financial assistance,” Kevin Patterson, CEO of Connect for Health Colorado, said in a news release. “On the other hand, it’s deeply troubling that a record number of people are canceling their plans because they simply can’t afford their monthly payments or are being forced to choose between health care and basic necessities like housing and food.”