The District of Columbia has around ~15,000 residents enrolled in ACA exchange plans. Unlike most states where nearly all ACA exchange enrollees are subsidized, in DC only around 28% are due to the District having an unusually high income eligibility threshold for Medicaid (210%).
DC also has a unique requirement that ACA individual market plans can only be sold on their ACA exchange; I'm assuming perhaps 1,000 off-exchange enrollees regardless but officially I believe this should be pretty much zilch. With net attrition since January, however, it looks like the grand total is actually a bit below 14,000 District-wide.
West Virginia has ~67,000 residents enrolled in ACA exchange plans, 97% of whom are currently subsidized. They also have an unknown number of off-exchange enrollees (likely only a few thousand at most).
Last week I urged Democrats to demand Congressional Republicans rein in the Trump Regime's out-of-control dictatorial rampage as well as going big on healthcare policy as part of the "government shutdown" battle...but that to the extent that they do make the main focus healthcare policy, at the very least to not settle for simply bumping out the enhanced ACA tax credits by a year or two:
You know I'm a pretty mainstream Democrat. I'm not demanding Medicare for All here. What I am urging on the healthcare front is for three clear demands:
Health Carriers Propose Affordable Care Act Premium Rates for 2026
Anticipated loss of federal enhanced premium tax credits leads to highest individual market rate increases proposed since the start of Maryland’s reinsurance program
BALTIMORE – The Maryland Insurance Administration has received the 2026 proposed premium rates for Affordable Care Act products offered by health and dental carriers in the individual, non-Medigap and small group markets, which impact approximately 502,000 Marylanders.
Maryland Insurance Administration Approves 2026 Affordable Care Act Premium Rates
Despite increases, Maryland remains a national leader in affordable rates; new state subsidy to offset loss of enhanced federal tax credits
BALTIMORE – Maryland Insurance Commissioner Marie Grant today announced the premium rates approved by the Maryland Insurance Administration for individual and small group health insurance plans offered in the state for coverage beginning January 1, 2026.
Rhode Island has around ~42,000 residents enrolled in ACA exchange plans, 88% of whom are currently subsidized. I estimate they also have another ~3,000 unsubsidized off-exchange enrollees.
With the ongoing budget battle approaching the Sept. 30th federal government shut down deadline, U.S. Senator Patty Murray (D-WA) and U.S. Representative Rosa DeLauro (D-CT-03) have formally introduced a bicameral Continuing Resolution bill to fund the government for an extra month to buy more time to negotiate and avoid a shutdown by the Republican-controlled federal government:
Today, Senator Patty Murray (D-WA), Senate Appropriations Committee Vice Chair, and Congresswoman Rosa DeLauro (D-CT-03), House Appropriations Committee Ranking Member, introduced a continuing resolution (CR) to keep the government funded and allow negotiations to continue over full-year bills that ensure Congress, not President Trump or Russ Vought, decide how taxpayer dollars are spent. The CR also addresses the health care crisis Republicans have single-handedly created and protects Congress’ power of the purse, rejecting President Trump’s illegal “pocket rescission.”
Speaker Johnson, Leader Jeffries, Leader Thune, and Leader Schumer,
We urge you to extend the Affordable Care Act’s enhanced premium tax credits. For millions of hard-working Americans, these subsidies are the only reason health insurance is still within reach in a country where the cost of living keeps going up.
If they expire, premiums will rise by thousands of dollars for many families, millions will lose coverage, and people will be forced to make impossible choices between paying for healthcare, rent, or groceries. Hard-working American families, older Americans not yet on Medicare, small business owners, and rural communities—where marketplace coverage is often the only option—will be hit the hardest.
I just finished writing up a deep dive into the Arkansas Insurance Dept's move from laissez faire-style Silver Loading to fully-regulated & maximized Premium Alignment in an attempt to mitigate the massive net premium damage about to be caused if the enhanced ACA premium tax credits expire at the end of 2025.
However, it's not just Arkansas which has finally seen the light and joined about a dozen other states in putting full-bore Premium Alignment (PA) pricing into place to help reduce the financial burden on ACA individual market enrollees in 2026.
Other states which have already done so in the past include Colorado (sort of), Texas, New Mexico, Maryland, Pennsylvania (somewhat), Illinois, Vermont and Wyoming.
State Highlights Rising 2026 Health Insurance Rate Proposals
SAINT PAUL, MN: Minnesotans are facing unnecessarily higher health insurance rate hikes, and the blame lies with new Republican-led federal policy changes passed in Washington, says Minnesota Commerce Commissioner Grace Arnold.
“While HR1 has been dubbed the “One Big Beautiful Bill” by Republicans, many in our state will find nothing beautiful in health insurance premium increases they’ll experience for 2026,” Arnold said. “These will be the highest rate hikes since 2017 for individual and group markets.”