Affordable Care Act users in West Virginia is declining due to national policy decisions

“The biggest factor (causing decreased use) is plan costs, specifically the loss of the enhanced premium tax credits… in place since 2021. With the rollback of the extra discounts, fewer people get financial aid. At the same time, the underlying cost of a plan also increased. The combination of higher rates and fewer discounts makes it hard for some people to afford a plan.” — Cate Deventer, ValuePenguin health insurance expert

According to a recently released report by ValuePenguin, Affordable Care Act premiums have risen nationwide by nearly 20% in 2026, leading to a 5% decrease in the use of ACA. This could mean that 1.2 million people who were on the ACA last year could go without coverage this year.

For 2026, West Virginia has the dubious honor of having the highest ACA premiums in the nation, at $1,314 per month. For comparative purposes, the lowest is Idaho, where premiums are less than half, only $509 monthly.

Unsurprisingly, West Virginia residents are decreasing their use of the Affordable Care Act at one of the highest rates in the nation. Plus, 38% are opting for high deductible “bronze” plans within the ACA, causing affordability issues when enrollees become ill.

The ACA coverage situation is much worse than other states, with 11,234 of West Virginia’s 67,113 enrollees (2025) dropping out. This is a 17% decrease in plan selections versus last year, the third highest decrease nationally. Only North Carolina and Ohio were more pronounced. 

Among “new enrollees,” defined as those looking to enroll for the first time, 44% of those in West Virginia dropped out after seeing the rates. This represents the highest new enrollee dropout rate of any state. The concern is that they will go without any insurance at all.

Fortunately, there is still federal financial assistance available (advance premium tax credits, cost-sharing reductions). These forms of aid are separate from the Biden era COVID-driven assistance that was removed by Congress in the Trump second term. And 89% of West Virginia residents do take advantage of this aid, bringing the monthly cost down to a more affordable $208 monthly.

Does this sound complicated and inefficient? The answer is a resounding “yes” — because it is. The United States has the most convoluted health insurance system in the world — with the highest cost and some of the worst results.

What is the solution? According to the West Virginia Chapter of Physicians for a National Healthcare Program, the answer is a single payer health system. The national organization has prepared an analysis of ACA versus Medicare for All.

Without getting into the weeds, the bottom line is that if we eliminate the corporate insurance company excesses (I know, I worked for one), we can save about 10% in overhead and marketing costs. And patient care would still be provided by the same non-governmental providers. That money can be used to provide direct care for patients who do not have insurance now. It is a big win for patients and the public. But a loss for Big Pharma and Big Insurance, which is why it has not happened. Remember this fact when you vote.