Alamance County sees sharp drop in Affordable Care Act enrollment

Affordable Care Act enrollment fell sharply in Alamance County as the cost of marketplace coverage climbed, raising the risk that more working families will go uninsured or be forced into higher medical debt. Preliminary data released by the Centers for Medicare & Medicaid Services showed the county’s drop stood out even in a state where enrollment declined in nearly every county.

North Carolina’s 2026 Marketplace enrollment slid from 975,110 in 2025 to 761,457 in 2026, a decrease of about 22 percent, or more than 214,000 people. KFF said North Carolina posted the largest percentage decline in the country, underscoring how strongly the end of enhanced federal premium subsidies hit households across the state. The enhanced tax credits expired Jan. 1, 2026, just as people were making coverage decisions for the year.

The 2026 open enrollment period for HealthCare.gov states ran from Nov. 1, 2025, through Jan. 15, 2026. During that window, people faced a one-two punch: North Carolina’s approved average rate increase for individual ACA policies was nearly 28.6 percent, with increases ranging from 16.88 percent to 36.4 percent, and KFF estimated the average marketplace deductible climbed from $2,759 in 2025 to $3,786 in 2026, a 37 percent jump. For many Alamance County residents, that meant monthly premiums and out-of-pocket costs were rising at the same time.

The pressure is likely to be felt most sharply by people who buy coverage on their own, including self-employed workers, part-time employees, and families who do not get insurance through an employer. As fewer people stay in the marketplace, the local fallout can spread beyond household budgets. Alamance County Health Department programs and Cone Health’s Alamance Regional Medical Center both serve a community where access to care is closely tied to insurance status, and a thinner pool of insured patients can mean more delayed care and more uncompensated bills for providers.

CMS said nearly 950,000 uninsured consumers had signed up for 2026 individual-market coverage by Dec. 5, 2025, and 23.0 million consumers had signed up nationwide by Jan. 28, 2026. But the Alamance County numbers show that statewide enrollment totals can hide local losses. In Burlington and across the county, the drop suggests the affordability squeeze is reshaping who can keep coverage and who is likely to fall out of the market.