发布时间：2026-01-29T03:29:28.509Z / 来源：CNN政治频道
作者：[塔米·卢比]
45分钟前
发布于 2026年1月28日，美国东部时间晚上10:29
医疗政策
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奥巴马医改参保人数减少
帕特里克·西松/美联社
根据周三发布的联邦数据，2026年选择奥巴马医改（平价医疗法案）医保计划的人数比去年减少了超过100万。这一下降是在联邦高额保费补贴到期后发生的，导致许多参保人的月度缴费大幅飙升。
根据医疗保险和医疗补助服务中心的数据，2026年有略低于2300万人选择了医保计划，而去年同期这一数字约为2420万。数据涵盖了使用联邦医保交易所的30个州的所有参保情况，这些州的开放注册期已于1月15日结束。但该数据未包含所有自行运营医保交易所的州的完整参保情况，其中一些州允许人们在本月底前继续注册。
然而，专家表示，未来几个月总参保人数可能会进一步下降。很大一部分消费者是被自动重新注册的，他们可能要到收到第一笔账单时才会意识到保费上涨了多少。这可能促使他们放弃医保或干脆不付款，从而在4月份被取消参保资格。
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保护我们的医保（Protect Our Care）倡导组织主席莱斯利·达赫在一份声明中表示：“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而停止支付保费，参保人数会逐月急剧下降。”
健康政策研究机构KFF的《平价医疗法案》项目主任辛西娅·考克斯表示，由于高额保费补贴的取消，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，今年保费支付预计平均将上涨114%。
国会预算办公室预测，由于更慷慨的联邦补贴到期，今年奥巴马医改计划的参保人数将减少200万。
这项高额补贴是拜登政府在2021年新冠疫情救济法案中推出的，但已于2025年底到期。这项额外援助大幅推动了奥巴马医改的参保人数增长，特别是惠及了低收入美国人，他们能够获得保费为零或极低的医保计划。高额补贴还让原本不符合补贴资格的中产阶级参保人也觉得医保更负担得起。
补贴的取消在国会山引发了激烈的党派之争，去年秋天导致了创纪录的长时间政府停摆。民主党坚持将联邦政府资金与延长补贴挂钩，但随着停摆持续，最终做出了让步。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，但由于共和党人的强烈反对，该法案在参议院未能推进。
2026年参保人数下降是自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，参保人数逐步下滑。
参保人数减少
特别是新客户对2026年奥巴马医改政策的兴趣有所下降。新参保人数略低于340万，较去年下降14%。续保客户约为1960万，下降了3%。
考克斯表示，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%）。而新墨西哥州和哥伦比亚特区的参保人数有所增加，分别增长14%和9%。
几个自行运营医保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。
科罗拉多州在州内注册期结束时，有略多于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。尽管该州实施了自己的保费援助计划以替代联邦高额补贴，但情况依然严峻。
科罗拉多州医保连接（Connect for Health Colorado）首席执行官凯文·帕特森在新闻发布会上表示：“一方面，看到参保人数相对稳定，仅略有下降，而且有创纪录的大量人获得了实质性的经济援助，这令人鼓舞。另一方面，有创纪录数量的人因无力承担月缴费用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，这令人深感担忧。”
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Obamacare enrollment drops after enhanced premium subsidies expire
Published Time: 2026-01-29T03:29:28.509Z / Source: CNN Politics
By
[Tami Luhby]
45 min ago
PUBLISHED Jan 28, 2026, 10:29 PM ET
Health care policy
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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.
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“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.”
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