This month marks both Women’s History Month and the 16th anniversary of the Affordable Care Act. What should be a time for the United States to reinforce its commitment to supporting women and advancing their health and well-being, is instead a moment where we are facing the cascading and predictable effects of actions taken by Congress last summer. The impacts of the largest loss of health care in U.S. history, the so-called One Big Beautiful Bill Act (H.R.1), are still materializing, but the damage will be devastating for women and families.
The expiration of Enhanced Premium Tax Credits (EPTCs), that H.R.1 failed to extend in 2025, has resulted in fewer people remaining eligible for tax credits that help make ACA Marketplace coverage more affordable. In fact, more than a million fewer people have signed up for 2026 ACA coverage, making it the first time since 2020 that enrollment has declined.
Women made up more than half of Marketplace enrollees last year, and these losses have enormous implications for their access to health coverage in the future.[1] While the full impact of the expired EPTCs on enrollment may not be fully known until later this spring or beyond, preliminary data on the size of drops in places like North Carolina and Ohio, states with the largest declines in overall plan selections, are so substantial that it is clear that the impacts on women are already being felt (See Appendix Table 1). Women in states like Georgia and Tennessee, that have not expanded Medicaid, are also at risk for outsized losses, falling into a coverage gap where they earn too much to qualify for Medicaid but are unable to afford unsubsidized Marketplace premiums.
ACA Marketplace premiums on average, have increased by more than 20 percent this year, which means, without enhanced subsidies, average annual premium payments more than doubled, from an average of $888 in 2025 to more than $1,904 in 2026.[2] These increased premiums will place a disproportionate burden on women who earn less than men, need more health care services, and face greater barriers to employer-sponsored coverage – barriers which are often even larger for women of color. More than 7 in 10 women are concerned about their ability to pay medical bills, with Black and Latina women reporting the highest levels of concern. As a result, women with low incomes and women with disabilities are more likely to defer or delay necessary medication or care, leading to worse health outcomes. Stories are already surfacing of women who have decided to go without health insurance this year due to increased premiums. While others have opted for health plans with lower premiums at the expense of higher deductibles and cost-sharing, risking financial hardship if a medical emergency arises.
The data so far only tell a limited story. Effectuated enrollment data – in other words, data on the number of people who have enrolled and have also paid their premiums – will be available in the coming months, along with more detailed demographic data. Together these data will provide a fuller picture of who and how many people have maintained coverage. Indeed, key ACA Marketplace insurers in recent earnings calls have reaffirmed that results will take time, revealing they expect nearly 3 million fewer ACA Marketplace enrollees by the end of this year.
During a month that is dedicated to elevating important areas of women’s progress, we must not forget the hard-fought historic gains and protections in women’s access to coverage over these last 16 years. Following the data and lifting up the needs of women who continue to navigate the rising health insurance costs, or lack access to health insurance altogether, must be a top priority. Now more than ever, state and federal policymakers must not let up in the fight to ensure all women have life-saving access to health care – the National Partnership for Women & Families certainly won’t.
Table 1: States with the Largest Reduction in Marketplace Plan Selections and Share of Female Marketplace Enrollees by State
1. If the declines are proportional to the overall gender breakdown, women would make up the majority of coverage losses, cancellations, or disenrollments.
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2. The average premium payment is among people currently receiving a tax credit in 2025. The 2026 average premium payment assumes gross premiums increase of 18% for those who lose tax credit eligibility.
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