94,000 Virginians Drop ACA Insurance

According to data from the State Health Benefit Exchange, 94,000 Virginians have dropped their Affordable Care Act (ACA) insurance so far this year, out of an estimated 100,000 people whom state health leaders had predicted would be vulnerable to losing coverage. Total enrollees stood at 389,000 in 2025 and have fallen to 295,000 as of this week.

The reduction is attributed in part to the expiration of subsidies that expanded the ACA marketplace to lower-income individuals. The debate over the issue triggered a government shutdown last year, and Congress ultimately let the subsidies lapse. When the decline reached 33,000 this spring, State Health Benefit Exchange Director Keven Patchett called it the “biggest drop-off in the first quarter that we’ve seen.” Virginia Association of Health Plans director Doug Gray said at the time that if the state could keep the number of people forfeiting insurance under 100,000, he’d “call that a victory.”

Del. Rodney Willet, D-Henrico, surmises the drop-offs this year may largely be due to the expired subsidies. He and fellow state lawmakers earmarked $150 million in Virginia’s current budget to create a temporary version of the expired assistance for Virginians between 138% and 250% of the federal poverty level. Eligible residents can tap into that relief when marketplace enrollment opens in November, potentially saving about 70% on monthly premiums. However, Willet acknowledged it is a temporary fix to a long-term challenge, saying, “trying to sustain that for years and years would be tough.”

The reconciliation bill passed by Congress last summer includes forthcoming changes to Medicaid eligibility and hospital funding mechanisms. Of Virginia’s nearly 2 million Medicaid enrollees, more than 500,000 will face new work requirements and additional verification paperwork each year, while about 5,800 lawful immigrants will lose coverage. Some may explore the state marketplace, but others may lose health insurance altogether. Gov. Abigail Spanberger recently issued an executive order to streamline efforts ensuring eligible Virginians do not lose coverage. Meanwhile, a state report found that pending hospital funding mechanisms may contribute to potential closure or reduced services for 13 rural hospitals, and hospitals predict a $31 billion reduction in state Medicaid funding over the next decade.

As part of negotiations during the reconciliation bill debate, federal lawmakers created the Rural Health Transformation Fund, a $50 billion investment for states over five years. Last week, officials announced the disbursement of $122 million of Virginia’s $189 million share. The money can be used to boost initiatives in rural areas to offset both longstanding healthcare access issues and potential shortfalls from the reconciliation bill. Willet noted, “(Those dollars) in no way replace what’s happening with the (Big Beautiful Bill). They will help around the edges, but this is a multi-billion dollar impact with the Medicaid disruption.”