Healthcare experts warned that the number of uninsured people would EXPLODE without federal subsidies for Affordable Care Act plans.
They were right.
The Republican refusal to extend health care subsidies into 2026 went off like a bomb in North Carolina. About 214,000 people in NC dropped off the ACA marketplace this year, according to NC Local. It’s the largest decline in America.
In a new Billy Ball Explains NC, we take a look at why this matters, whether you still have health insurance or not. It is, truly, a life-and-death story.
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Transcript
Nobody likes an “I told you so.”
Bill: But you’re about to do it anyway, aren’t you?
(struggling to find the words)
Yes.
Last year, health care advocates warned us all that hundreds of thousands of people could lose coverage if federal health care subsidies expired.
Well, the numbers are in. And the loss of subsidies went off like a bomb in NC.
So far in 2026, NC has recorded the largest drop in Affordable Care Act enrollment in the entire country. About 214,000 North Carolinians dropped their coverage so far this year, and that number is gonna keep going up.
Let me tell you what that means, and why you should care, whether you still have health insurance or not.
This is Billy Ball Explains NC. Every week, we break down the most important stories in NC, as told by a veteran NC journalist—me. Make sure to tap like and subscribe below so you don’t have to count on the algorithm to keep up.
Bill: Veteran is an amazing euphemism for “old.”
(looking off-camera) Don’t you have something better to do?
Bill: (looking at wrist) Nothing presented itself.
Ok, we have really important things to talk about this week. Life or death-type things.
New data shows North Carolina’s enrollment in the Affordable Care Act is plummeting across the state. According to NC Local, enrollment dropped in 98 of North Carolina’s 100 counties.
And honestly, it’s not really a mystery why.
During the COVID-19 pandemic, Democrats in Congress and the Biden administration passed enhanced federal health care subsidies to help more people afford insurance. Those subsidies lowered the cost that people paid every month for coverage.
But in 2025, the Republican-controlled Congress refused to extend them. Remember? It was the whole reason for that historically long government shutdown in 2025.
Healthcare experts warned that without the subsidies, millions of Americans would see their insurance costs go up, and many would be forced to drop coverage altogether.
That’s exactly what happened. In record numbers.
Bill: That was an ‘i told you so!’
Without the subsidies, people are seeing their monthly out-of-pocket expenses jump 30% or more this year.
Basically, people are paying a lot more money for the exact same coverage or worse.
Bill: Well, this is just Trump owning the libs, right?
No, this is a self-own.
As the nonpartisan health policy organization KFF reported last year, more than 3 out of every 4 people enrolled in the ACA lived in states won by Trump.
That includes North Carolina.
No one relied on those subsidies more than rural places, especially in the South. Since the subsidies were first expanded, enrollment in the ACA marketplace more than doubled nationwide, and more than half of that growth was in four Southern states—Florida, Georgia, Texas, and—you guessed it—North Carolina.
Despite that, every single Republican who represents North Carolina in the US House and Senate—with the exception of retiring Sen. Thom Tillis—opposed extending subsidies.
Here’s another stat to sit with: More than 1 in 5 Americans who signed up through Healthcare.gov—which is what we use to enroll in the ACA in North Carolina—were dropped in 2026 because they didn’t pay the first month’s premium.
I know how some folks think so let’s just say it: These subsidies aren’t going to lazy, do-nothings.
They’re going to farmers.
They’re going to self-employed workers.
They’re going to small business owners and their employees.
They’re going to people whose jobs don’t provide affordable health insurance.
Bill: It’s because all those illegals got insurance right?
No, undocumented people can’t get insurance through the ACA.
(pregnant pause)
Jerk.
Now, sure, some of those folks who left ACA plans might have gotten their health insurance elsewhere. But let’s be real. Most of those people are just dropping health insurance because they can’t afford it. And they can’t afford it because Republicans in Congress allowed the subsidies to expire
Folks are making decisions about what they need right now to keep the lights on, to buy groceries, to put gas in the car, to make rent or pay the mortgage.
And health insurance is one of the first things people think they can live without.
Bill: Ok, wrap it up, Poindexter.
Here’s why this matters. When people don’t have health insurance, they don’t stop getting sick. They just go to the doctor less, if at all. They spend more time in ERs. Small illnesses become major illnesses.
And, yes, they die younger.
Those aren’t opinions. That’s what happens when people don’t have health insurance. It’s backed up by years and years of research.
Bill: Yeah, but I got insurance. Who cares?
Even if you have health insurance right now, this still impacts you. And the reason is pretty simple.
America’s big, flawed health care system relies on people having insurance. When they don’t have coverage, they only see a doctor during emergencies.
And when they can’t afford to pay those medical bills, it leaves hospitals and medical providers with billions of dollars in unpaid claims. They offset those losses by making health care cost more for everyone.
In other words, when some people don’t have health insurance, it drives up the cost of care for everybody.
Let’s wrap it all up.
Bill: Oh thank god.
This isn’t really about political ideology. It’s about facts and figures. We have a lot to figure out about healthcare in this country.
Democrats are going to have to face up to the huge flaws in the ACA and get to work fixing them. The ACA wasn’t designed to solve every problem in American healthcare. It was designed to help more people get coverage And for millions of Americans, including hundreds of thousands in North Carolina, it did exactly that.
And Republicans, in the last 20-something years, well they have yet to put forward any type of plan for fixing healthcare other than “go to hell Democrats.”
Now, many of those same people who got health care because of the ACA are losing it because the financial help that made their insurance affordable is gone.
If this video was helpful, check out the recent Billy Ball Explains NC on universal healthcare and what healthcare looks like in other countries compared to the United States.
Also, make sure to tap “like” and subscribe below, and check out the free daily newsletter I write for Cardinal & Pine putting North Carolina news in context. We’ll put the link in the description.
