When the enhanced Affordable Care Act subsidies expired, Black enrollees in California cancelled their coverage at nearly twice the rate of the year before. Among Black consumers with incomes between 150% and 400% of the poverty line, Covered California’s own renewal analysis found a 29.4% cancellation rate in 2026, up from 16% in 2025. Open enrollment for 2027 began Nov. 1, and premiums are rising again.
The gap shows up even when income is held constant. Among enrollees at 200% to 250% of the poverty line, termination rates were 30% for Black enrollees, 23% for Latino enrollees and 17% for white enrollees. California is one of the few states that publishes the numbers by race, and it also tops up federal aid for its lowest-income enrollees, which Covered California found kept retention steady among them. Black families in the middle of the income range, who lost federal help and got no state cushion, are the ones who left.
No national figure shows the same thing, because KFF’s national tallies are not broken out by race. That absence matters. It means the federal government can take 1.2 million fewer sign-ups in a year, as KFF reports, without anyone being required to say which communities lost the most.
The national numbers are already large. Active marketplace coverage fell 12% to 19.2 million people by February 2026, according to KFF. Average deductibles rose 37%, by more than $1,000, to $3,786 as the enhanced tax credits ended. KFF projects benchmark silver premiums will rise 13% on average for 2027, after a similar jump this year.
The Deep South shows what that looks like where the Black population is large and states do not top up federal aid. Louisiana’s marketplace enrollment fell 26%, from 264,790 to about 194,790, The Lens reported, among the steepest drops in the country. Mississippi had the lowest retention rate in the nation, 61% past January. Louisiana’s Medicaid rolls separately shed 200,000 people in 12 months. Premium payments after tax credits rose 58% for Louisiana enrollees.
The administration says it is cleaning up the exchanges. Vice President JD Vance announced about 760,000 people would be removed in September over alleged fraud, with projected federal savings of $2.2 billion, Black Enterprise reported. Removing fraud is one thing. But the cancellations in California came from people who were eligible, who kept their subsidy, and who found the bill too high anyway.
The cost of that falls on a population that already has less cushion. People who drop coverage skip the screening, the blood pressure pill and the prenatal visit, and in Black communities with higher rates of hypertension, maternal complications and diabetes, those are not small things.
Congress let the subsidies lapse, and a Congress that changes hands in January can restore them. Black enrollees who cancelled this year are owed that vote, and Democrats who just won on the cost of living should hold it. Enrollment closes Jan. 15, 2027.
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