作者：塔米·卢比（Tami Luhby） | 1小时15分钟前 | 发布于2026年1月28日，美国东部时间晚上10:29
根据周三发布的联邦数据，2026年《平价医疗法案》（Affordable Care Act，ACA）的参保人数减少了超过100万。这一下降是在联邦增强型保费补贴到期后发生的，导致许多参保人的月缴费额大幅飙升。
美国医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）数据显示，2026年约有2300万人选择了医保计划，相比之下，去年同期约有2420万人参保。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 于1月15日结束。但是，该数据未涵盖所有自行运营交易所的州的完整参保情况，其中有几个州允许人们在本月底前继续登记。
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续缴了保单，但直到收到第一张账单才意识到保费会大幅上涨。这可能促使他们放弃医保或干脆不缴费，从而在4月份被取消参保资格。
“这个数字并没有说明全部情况。随着人们发现自己负担不起医疗费用而停止支付保费，参保人数将逐月急剧下降，”倡导组织“保护我们的医保”（Protect Our Care）主席莱斯利·达赫（Leslie Dach）在一份声明中表示。
健康政策研究组织KFF的ACA项目主任辛西娅·考克斯（Cynthia Cox）表示，由于增强型保费补贴到期，继续参保的人可能面临更高的保费或更高的免赔额。KFF的数据显示，今年保费平均预计将上涨114%。
国会预算办公室（Congressional Budget Office）预计，由于更慷慨的联邦补贴到期，今年将有200万人失去《平价医疗法案》的医保覆盖。
增强型补贴是拜登政府在2021年《新冠疫情纾困法案》中推出的，但已于2025年底到期。额外的援助曾大幅推动《平价医疗法案》参保人数激增，特别是在低收入美国人中，他们原本可以获得保费为零或极低的医保计划。增强型补贴还使中产阶级参保人更容易负担医保费用，而这些人此前不符合获得补助的资格。
补贴到期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，但随着停摆的持续，最终做出让步。上月，众议院在几名共和党议员与民主党人共同投票支持后，通过了一项为期三年的补贴延期法案，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年以来的首次下降，当时有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。
参保人数减少情况
2026年《平价医疗法案》的政策吸引新客户的兴趣尤其下降。新参保消费者约有340万人，较去年下降14%。回头客约1960万人，下降3%。
整体参保人数下降幅度最大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。但最大的增长出现在新墨西哥州（计划选择量激增14%）和哥伦比亚特区（增长9%）。
几个自行运营交易所的州的参保人数出现下降，因为更多人取消了今年的医保计划。
在科罗拉多州，到该州参保期结束时，约有27.7万人选择了医保计划，较去年下降2%。新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替代联邦增强型补贴，但情况依然严峻。
“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实质性的经济援助，这令人鼓舞，”科罗拉多州医保连接项目（Connect for Health Colorado）首席执行官凯文·帕特森（Kevin Patterson）在新闻发布会上表示。“另一方面，创纪录数量的人因为无法负担月缴费而取消医保计划，或被迫在医疗保健和住房、食品等基本生活必需品之间做出选择，这令人深感不安。”
Obamacare enrollment drops after enhanced premium subsidies expire
By Tami Luhby | 1 hr 15 min ago | PUBLISHED Jan 28, 2026, 10:29 PM ET
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.”