Loss of Tax Credits Drives Up Covered California Premiums for Middle-Income Valley Residents

New enrollments in the state's health insurance marketplace down by nearly one-third as expanded COVID-era subsidies expire.

Apr. 14, 2026 at 11:13pm

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A translucent, ghostly X-ray photograph of a human heart, its intricate structures glowing against a dark background, conceptually representing the internal vulnerabilities of the healthcare system.As the affordability crisis in healthcare coverage deepens, the fragile state of the system is laid bare.Tulare Today

The expiration of enhanced tax credits that helped subsidize health insurance premiums through the Affordable Care Act's Covered California marketplace has led to a significant increase in out-of-pocket costs for middle-income individuals and families across the San Joaquin Valley. This has resulted in a 32% drop in new enrollments over the past year, as well as an increase in coverage cancellations, as people struggle to afford the higher premiums.

Why it matters

The loss of the expanded COVID-era subsidies has disproportionately impacted middle-income Californians who rely on Covered California for their health insurance, forcing many to choose less comprehensive plans with higher deductibles or go uninsured altogether. This threatens to reverse the progress made in reducing the state's uninsured population under the Affordable Care Act.

The details

Almost 2 million Californians purchased health insurance through Covered California in 2025, with the vast majority being people without employer-provided coverage, self-employed, or making too much for Medi-Cal. In the San Joaquin Valley, new Covered California enrollments dropped 32% in 2026 compared to 2025, from 32,400 to just over 22,000 people. The PPIC estimates the average annual premium for middle-income enrollees increased by over $5,200 per person in Fresno County and over $10,000 per person in Merced County after the expiration of the expanded tax credits.

  • The enhanced subsidies enacted during the COVID-19 pandemic expired on December 31, 2025.
  • Open enrollment for 2026 Covered California plans took place in late 2025.

The players

Covered California

The state's health insurance marketplace under the Affordable Care Act, where individuals and families can purchase private health plans.

Public Policy Institute of California (PPIC)

A nonpartisan think tank that conducted a county-by-county analysis on the impact of the expiration of the enhanced Affordable Care Act subsidies.

Jessica Altman

The executive director of Covered California.

Drew Altman

The president and CEO of KFF, an independent health policy research organization.

KFF

An independent health policy, research, and news organization.

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What they’re saying

“The uninsured is not the most politically salient problem in health care now – that's affordability – nor is it the non-problem some say it is. But it's coming back. And the problem of the chronically ill uninsured is glaring.”

— Drew Altman, President/CEO, KFF

What’s next

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The takeaway

This case highlights growing concerns in the community about repeat offenders released on bail, raising questions about bail reform, public safety on SF streets, and if any special laws to govern autonomous vehicles in residential and commercial areas.