Affordable Care Act Marketplace enrollments in Mississippi are down about 8% compared to the same time last year following the expiration of enhanced subsidies that made health insurance more affordable for millions of Americans, according to initial data from the federal government published last week.
As of Jan. 3, over 307,000 Mississippi had made selections for Marketplace health plans, which primarily insure small business owners, employees, farmers or people who are self-employed, according to Centers for Medicare and Medicaid Services data. That figure trends down from 330,000 people enrolled at about the same time last year — a year that marked an all-time high for enrollments in Mississippi. Open enrollment closed Jan. 15.
“This dip is alarming, but we don’t have all the data needed to give us the real picture of the impact of the enhanced premium tax credits going away,” said Kimberly Hughes, government relations director for the American Cancer Society Cancer Action Network in Mississippi, in a statement.
Experts told Mississippi Today they expect enrollments to fall further, because people may disenroll from coverage when they receive their first bill reflecting a higher monthly premium.
The enhanced subsidies, which made coverage more affordable for over 22 million Americans, were an added boost authorized by Congress in 2021 to raise the income ceiling for eligibility and allow low-income households to access insurance without paying premiums during the COVID-19 pandemic.
During that time, the number of Mississippians enrolled in Marketplace health insurance tripled. That increase amounted to over 200,000 people between 2021 and 2025, according to enrollment data from the Centers for Medicare and Medicaid Services. During the same period, the rate of people without insurance – one of the highest rates in the country – dropped by over 65,000 people.
But without the enhanced subsidies, the cost of premiums for Marketplace plans will more than double on average this year, according to KFF, though the rate changes will vary based on age, income and location.
Republicans and Democrats in Congress have tussled for months over whether or not to extend the subsidies, but have not yet reached a deal. The House of Representatives passed a three-year extension of the subsidies on Jan. 13 after over a dozen Republicans broke with their party to support their renewal. The Senate rejected a similar proposal in December, with Sens. Roger Wicker and Cindy Hyde-Smith voting against extending the subsidies.
Because Mississippi has opted not to expand Medicaid coverage, more low-income people depend on the Marketplace for health coverage, said Khaylah Scott, program manager for the Mississippi Health Access Program.
“For a lot of Mississippians, this is their only option,” she said.
The drop in plan selections in Mississippi is twice as high as the country as a whole. Nationwide, Americans saw a 4% decrease based on initial numbers. U.S. enrollment declined by about 800,000 people compared to the same time period last year and about 1.5 million people from last year’s total enrollment.
Scott said her organization has clearly seen the effects of the expiring subsidies in a surge of calls to its free helpline, Health Help Mississippi.
The nonprofit logged about 1,000 intakes last year, up from 400 the year before. Just two weeks into the new year, the program had already performed over 100 intakes.
Among the callers, Scott said, was a woman calling on behalf of her brother, who has congestive heart failure. His premium for Marketplace insurance last year was $25, but this year, he was quoted at over $300 a month. He doesn’t have the option to let his coverage lapse, and plans to be more frugal and cut back on unnecessary spending in order to save up for the higher premium.
A 63-year-old woman who called the help line saw her premiums increase from $70 to $540 a month. She will go without health insurance for a year and a half, when she becomes eligible for Medicare. Her 25-year-old son, whose premiums rose $395 a month, will also go without coverage.
Scott said it’s been difficult for her organization to listen to Mississippians share their struggles accessing affordable health insurance coverage, knowing there is little they can do to help lower costs.
“It’s been really tough telling people there’s nothing we can do…. It’s really in Congress’ hands right now.”
The Urban Institute, a policy think tank, predicted in September that about 150,000 people in Mississippi would drop their Marketplace coverage if the increased subsidies were not extended — one of the steepest dropoffs in the country. The organization also estimated that uninsurance rates in Mississippi would rise by 65%.
Initial data shows a less steep drop off in coverage, but there is no evidence to suggest that the estimates should be adjusted at this point, said Matthew Buettgens, one of the authors of the study.
Buettgens said he expects to see a more clear picture of how the expired subsidies have influenced enrollment when data showing the number of people who have paid their initial premium payments is released. This data is typically released in the summer.
CMS data shows that more than half of Mississippians insured through the Marketplace were automatically re-enrolled last year, suggesting many people may not have reviewed their premiums or actively updated their coverage this year.
Though open enrollment has now ended, Congress could opt to create an additional enrollment period, he said. But even so, many people will still experience a gap in coverage or pay higher premiums in order to maintain their insurance.
Several states, including Connecticut and Pennsylvania, have extended their open enrollment period through the end of the month to give people more time to sign up.
The expiration of Marketplace subsidies is also not the only factor expected to affect health insurance coverage rates, Buettgens said, pointing to changes in the One Big Beautiful Bill Act passed by Congress and signed into law by President Donald J. Trump this summer.
The law requires more frequent eligibility determinations for Medicaid beginning at the end of this year, which is expected to result in fewer people with health insurance. Fewer lawfully present immigrants, including refugees, people granted political asylum and victims of domestic violence and trafficking will be eligible for Medicaid or Marketplace financial assistance beginning in 2026.
“The declines that we see this year, that’s not the end of it,” Buettgens said.
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