How much more are ~300,000 INDIANA ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at INDIANA:

Here's a look at Illinois ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

As expected, enrollment below the federal poverty level (FPL) has plummeted by nearly 70%, due mostly to the Trump Regime eliminating federal subsidy eligibility to low income legally-residing immigrants who have been U.S. residents for less than 5 years, along with some other categories of documented immigrants. 

Enrollment at every other income bracket has also dropped, in most cases dramatically: The 400 - 500% FPL bracket is down over 35% year over year.

Overall, OEP plan selections were already down by nearly 17% before effectuated enrollment even began, with over 59,000 fewer Hoosiers enrolled out of the gate:

OK, onto the main analysis: Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by raw metal level:

When you break the Silver plans out by CSR category, the average Actuarial Values for both years change dramatically, since a huge chunk of ACA enrollees are generally low-income enough to be eligible for Cost Sharing Reduction (CSR) assistance, which boosts Silver plans up to Platinum levels of AV for most CSR enrollees. In the end, the average AV has dropped by 2.1 points year over year:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

In Indiana, the ~300,000 enrollees who signed up during Open Enrollment have seen their net premiums skyrocket by 85% on average.

In addition, their average out of pocket expenses have gone up by nearly 40%, for a combined average healthcare cost increase of 63%.

That's an increase from ~$2,800 to ~$4,500 per enrollee this year...nearly $1,800 more apiece.

In addition, based on KFF's net data, average deductibles also jumped by ~20% to around over $3,700 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: IOWA.