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Covered California<\/a>, the state\u2019s insurance marketplace under the Affordable Care Act, is seeing marked declines in enrollment as well as a substantial number of people cancelling their coverage following the expiration of tax credits to help consumers pay for insurance premiums.<\/p>\n The final deadline for open enrollment in health coverage under Covered California is Saturday night, Jan. 31, for coverage to start Feb. 1. The next open enrollment period in which people can sign up for coverage won\u2019t be until November.<\/p>\n Information and assistance about Covered California open enrollment is available online at\u00a0www.coveredca.com<\/a>.<\/p>\n \u201cBecause of the federal government\u2019s failure to extend the enhanced premium tax credits, we are already seeing the impact in California,\u201d said Dr. Monica Soni, chief medical officer for Covered California, in a Jan. 27 press conference in Fresno. \u201cFewer Californians are coming in to enroll [and] more folks are canceling, particularly those middle-income families, hard-working families.\u201d<\/p>\n \u201cWe estimate that we might lose as many as 400,000 Californians who might drop their coverage and potentially go uninsured,\u201d she added.<\/p>\n About 2 million California residents purchase health insurance through Covered California. The vast majority of those are people whose employers don\u2019t provide health coverage to employees, self-employed business owners, freelance \u201cgig economy\u201d workers, and people who make too much money to qualify for Medi-Cal, the state\u2019s incarnation of the federal Medicaid program for low-income residents.<\/p>\n As of July 2025, about 202,000 residents in the San Joaquin Valley, from San Joaquin County in the north to Kern County in the south, were enrolled in Covered California. More than 90% have at least part of their costs for premiums subsidized by tax credits.<\/p>\n The Affordable Care Act originally included tax credits to subsidize health insurance premiums for households earning up to 400% of the federal poverty level. The tax credits were expanded in 2021 as part of COVID-19 relief legislation for people or families with incomes above that level, and capping the out-of-pocket cost of premiums at 8.5% of income.\u00a0<\/p>\n But that expanded subsidy program came with a Dec. 31, 2025 expiration date.<\/p>\n In a separate interview, Soni told the Central Valley Journalism Collaborative that 2025 was a record year for health insurance enrollment through Covered California, \u201cin part because of how much affordability we had been able to offer; we were able to eliminate deductibles, which is really incredible.\u201d<\/p>\n But for 2026 coverage, \u201calready we see, in terms of new enrollments, about a 30% decrease in new enrollments,\u201d Soni said. \u201cAnd we also see about a 30% shift in those new enrollees\u201d who are downshifting from a mid-tier insurance plan to more basic plans that come with lower premiums, but also higher deductibles and less comprehensive coverage.<\/p>\n \u201cThose are the type of plans that people have to make because of their budgets, but actually do impact their ability to access care\u201d and prompt families to delay care because of cost, she added.<\/p>\n Rep. Jim Costa, D-Fresno, criticized Congress for failing to extend the expanded tax credits before they expired on Dec. 31, as well as for substantial cuts to the Medicaid insurance program for low-income Americans that were included in H.R. 1, backed by President Trump and Congressional Republicans and passed last summer.<\/p>\n \u201cClearly, with the changes that have taken place, we should never, in the richest country in the world, consider health care to be a luxury item,\u201d he said. \u201cAll Americans ought to be able to have access to affordable health care.\u201d<\/p>\n Costa said that in 2010, prior to the passage of the Affordable Care Act \u2013 sometimes called \u201cObamacare\u201d \u2013 Congressional districts in the Valley had about 24% of their constituents who were uninsured. By 2020, that had dropped to 10%. \u201cThat happened because we created an opportunity for more Americans, millions of Americans, to be able to achieve health insurance,\u201d he said.<\/p>\n In Washington, D.C., the House of Representatives recently passed legislation that would reinstate the expanded tax credit with some compromises, Costa said, but it is unclear if the U.S. Senate will follow suit.<\/p>\n \u201cWith the federal government reducing its participation, it has an impact on whether or not people can stay under the insurance plan that they have,\u201d he said. \u201cIn my congressional district, over 22,000 families would be directly impacted if we are not able to come to some agreement by the end of this month.\u201d<\/p>\n The largest volume of cancellations statewide are among individuals and households that benefitted from the COVID-era expansion of the tax credits. \u201cThose are our middle-income families that now have no financial support at all,\u201d Soni told CVJC. \u201cThat\u2019s what we used to call \u2018the cliff,\u2019 and they\u2019re back on that cliff and they are canceling at double the rates\u201d of those who still have some level of tax credit or subsidy to help pay for their insurance premiums.<\/p>\n Still, Soni and other health advocates said that many customers are still eligible for some level of financial assistance paying for their coverage, but have yet to enroll in Covered California.<\/p>\n \u201cHere in Central California, including [Fresno], more than 200,000 residents are enrolled in Covered California, and over 90% of those enrollees receive financial assistance to help lower the cost of their monthly premiums,\u201d said Annalisa Perea, a member of the Fresno City Council.<\/p>\n However, \u201can estimated 147,000 people in the Central Valley remain uninsured but are eligible for coverage, including about 61,000 who qualify for Covered California subsidies,\u201d Perea added. \u201cToo often, people assume coverage is out of reach, or believe they do not qualify, when in reality many are eligible for meaningful assistance that can significantly reduce monthly costs.\u201d<\/p>\n Having health insurance \u201cis about increasing access to care,\u201d said Sandra Celedon, president and CEO of Fresno Building Healthy Communities, an advocacy organization. \u201cThat\u2019s the goal. We know people who are uninsured delay care, leading to financial stress [and] higher medical costs.\u201d<\/p>\n \u201cInsured individuals are more likely to have a regular doctor \u2026 and access the necessary medications, leading to better management of chronic conditions,\u201d Celadon added. \u201cBut we also need to make sure there\u2019s consistent access to care that is supported by insurance, which is why we need consistent funding for the premium assistance that is available under Covered California.\u201d<\/p>\n Soni, who continues to see patients as a physician with a board certification in internal medicine, told CVJC that before the Affordable Care Act, she would frequently encounter patients in hospital emergency rooms or her clinical practice with advanced diseases that could have been prevented with earlier care.<\/p>\n \u201cI honestly don\u2019t see that anymore,\u201d she said. The Affordable Care Act \u201chas been transformative for us in the state of California. We\u2019re catching diseases earlier. We\u2019re getting people into care. They\u2019re getting specialty care and they\u2019re living longer.\u201d<\/p>\n With more people having health coverage through Covered California, \u201cwe do millions of cancer screenings each year, we are catching folks with earlier diagnoses, we are keeping people out of the emergency room [and] out of the hospital with the current structure that we have,\u201d Soni said.<\/p>\n \u201cI\u2019m extremely worried about what happens, with the cancellations and the delays in care,\u201d she added. \u201cAll of the safety net systems we had before, we don\u2019t have anymore. \u2026 So I have my fingers and toes crossed that we might have action in Congress, but I\u2019m extremely worried as a frontline provider.\u201d<\/p>\n Tim Sheehan is the Health Care Reporting Fellow at the nonprofit\u00a0Central Valley Journalism Collaborative<\/a>. The fellowship is supported by a grant from the\u00a0Fresno State Institute for Media and Public Trust<\/a>. Contact Sheehan at tim@cvlocaljournalism.org.<\/p>\n Like this:<\/p>\n Like Loading…<\/p>\n