Millions of Americans faced a critical deadline on Thursday, 15 January 2026, as the window to select health insurance under the Affordable Care Act (ACA) closed across a majority of states. The annual ritual was overshadowed by significant financial uncertainty, as crucial federal subsidies that had kept premiums low for millions expired at the start of the year.
Deadline Day Arrives Amidst Political Stalemate
Thursday marked the end of the open enrolment period for plans beginning in February for most states. However, approximately ten states that operate their own insurance marketplaces have set later deadlines, with some extending them to the end of January to offer residents more time. This date is particularly vital for an estimated 24 million Americans who purchased ACA plans last year, including small business owners, gig economy workers, farmers, and others who do not receive employer-sponsored health cover.
This year's enrolment process has been uniquely challenging. Federal data indicates that sign-ups are lagging behind last year's record pace, with about 22.8 million Americans having enrolled so far. The primary cause of the slowdown is the expiration on 1 January of enhanced, COVID-era subsidies. These subsidies had offset costs for more than 90% of people using the marketplace. Their lapse has left the average subsidised enrollee facing monthly premium costs more than double those of 2025, according to an analysis by the non-profit health research group KFF.
Enrollees in Limbo as Congress Debates
The shadow of unresolved political debate in Washington has left many potential policyholders in a state of anxious suspension. Several enrollees told The Associated Press they had either delayed signing up altogether or enrolled with plans to cancel, hoping for a last-minute legislative reprieve. The issue previously led to a record-long government shutdown orchestrated by Democrats, who failed to secure a deal before the subsidies lapsed.
There is, however, a flicker of movement on Capitol Hill. Last week, the US House of Representatives passed a three-year extension of the subsidies after 17 Republicans broke ranks to join Democrats. The Senate, however, rejected a similar bill last year. A bipartisan group of 12 senators, led by Republican Senator Bernie Moreno of Ohio, is now attempting to forge a compromise. Moreno stated this week that he expects to have a proposal ready by the end of January.
Contours of a Potential Bipartisan Deal
The emerging Senate plan involves a two-year deal. It would temporarily restore the enhanced subsidies but pair them with new limits on eligibility. The proposal also includes a provision favoured by former President Donald Trump and many Republicans: the creation of a new health savings account option in the plan's second year. Notably, the discussed deal would also extend the ACA open enrolment period to 1 March 2026, granting people more time to make decisions after the recent disruption.
Despite these negotiations, significant hurdles remain. Republicans and Democrats confirm they have not finalised the plan, and the two sides are yet to agree on whether to impose new limits on states using separate funds to provide abortion coverage. For now, with the deadline passed in most states and costs sharply higher, millions of Americans are navigating their healthcare futures without the financial safety net they have relied on for years.
Associated Press writers Mary Clare Jalonick and Lisa Mascaro contributed from Washington.
