These GOP states would suffer the biggest blows if Affordable Care Act subsidies expire

The issue is at the heart of the longest federal government shutdown on record, with Democrats pushing to extend the benefits and Republicans wanting to let them expire at the end of the year.

Currently, the online marketplace for ACA health plans prices prices without subsidies. Open enrollment for coverage in 2026 began this month, with premiums doubling on average, according to the nonpartisan health policy research group KFF. This is due to the expiration of ACA subsidies and rising insurance company rates.

In an October 23 memo, Matthew Martin, chief U.S. economist at Oxford Economics, noted that more than half of the 24 million enrollees receiving these subsidies live in a few Southern states.

“Southern states have a much higher share because most of these states did not expand Medicaid coverage in the 2010 ACA or the American Rescue Plan Act of 2021 despite federal support to do so,” he wrote.

Of the 10 states with the highest percentage of residents receiving Obamacare benefits, eight are in the South and voted for President Donald Trump last year. They include Florida, Georgia, Texas, Mississippi, South Carolina, Alabama, Tennessee, and North Carolina. The other two states in the top 10, Utah and Wyoming, are also Republican states.

States that expanded Medicaid under the ACA allowed more low-income people to obtain health coverage.

For other states, low-income people who don’t meet the program’s requirements can still get subsidies for enrolling in Obamacare plans that fully or nearly fully offset the cost.

The subsidies have helped ACA enrollment more than double since 2020. But the expiration of the subsidies would leave enrollees exposed to the full cost.

A KFF analysis last month of ACA market data found that 57% of enrollees live in Republican-represented congressional districts.

In fact, all of the congressional districts in Florida, Georgia, Mississippi, and South Carolina have at least 10% of their residents enrolled in Obamacare plans, according to KFF. This applies to almost all areas in Texas and Utah.

The Congressional Budget Office has estimated that extending ACA benefits would cost $35 billion annually. Meanwhile, the Congressional Budget Office said allowing it to expire would result in about 4 million people becoming uninsured by 2034.

In addition to financial costs, there may be political costs if voters see their health insurance costs rise. Affordability was a major issue in last week’s off-year elections, and subsidies have emerged as an issue for next year’s midterm elections.

“While a relatively small percentage of the national population gets its coverage through the ACA marketplaces, in some areas, the number of ACA enrollees may be enough to swing a close election,” KFF said last month.