Covered California, the state’s insurance marketplace under the Affordable Care Act, is seeing marked declines in enrollment as well as a substantial number of people cancelling their coverage following the expiration of tax credits to help consumers pay for insurance premiums.
The final deadline for open enrollment in health coverage under Covered California is Saturday night, Jan. 31, for coverage to start Feb. 1. The next open enrollment period in which people can sign up for coverage won’t be until November.
Information and assistance about Covered California open enrollment is available online at www.coveredca.com.
“Because of the federal government’s failure to extend the enhanced premium tax credits, we are already seeing the impact in California,” said Dr. Monica Soni, chief medical officer for Covered California, in a Jan. 27 press conference in Fresno. “Fewer Californians are coming in to enroll [and] more folks are canceling, particularly those middle-income families, hard-working families.”
“We estimate that we might lose as many as 400,000 Californians who might drop their coverage and potentially go uninsured,” she added.
About 2 million California residents purchase health insurance through Covered California. The vast majority of those are people whose employers don’t provide health coverage to employees, self-employed business owners, freelance “gig economy” workers, and people who make too much money to qualify for Medi-Cal, the state’s incarnation of the federal Medicaid program for low-income residents.
As of July 2025, about 202,000 residents in the San Joaquin Valley, from San Joaquin County in the north to Kern County in the south, were enrolled in Covered California. More than 90% have at least part of their costs for premiums subsidized by tax credits.
The Affordable Care Act originally included tax credits to subsidize health insurance premiums for households earning up to 400% of the federal poverty level. The tax credits were expanded in 2021 as part of COVID-19 relief legislation for people or families with incomes above that level, and capping the out-of-pocket cost of premiums at 8.5% of income.
But that expanded subsidy program came with a Dec. 31, 2025 expiration date.
In a separate interview, Soni told the Central Valley Journalism Collaborative that 2025 was a record year for health insurance enrollment through Covered California, “in part because of how much affordability we had been able to offer; we were able to eliminate deductibles, which is really incredible.”
But for 2026 coverage, “already we see, in terms of new enrollments, about a 30% decrease in new enrollments,” Soni said. “And we also see about a 30% shift in those new enrollees” who are downshifting from a mid-tier insurance plan to more basic plans that come with lower premiums, but also higher deductibles and less comprehensive coverage.
“Those are the type of plans that people have to make because of their budgets, but actually do impact their ability to access care” and prompt families to delay care because of cost, she added.
Rep. Jim Costa, D-Fresno, criticized Congress for failing to extend the expanded tax credits before they expired on Dec. 31, as well as for substantial cuts to the Medicaid insurance program for low-income Americans that were included in H.R. 1, backed by President Trump and Congressional Republicans and passed last summer.
“Clearly, with the changes that have taken place, we should never, in the richest country in the world, consider health care to be a luxury item,” he said. “All Americans ought to be able to have access to affordable health care.”
Costa said that in 2010, prior to the passage of the Affordable Care Act – sometimes called “Obamacare” – Congressional districts in the Valley had about 24% of their constituents who were uninsured. By 2020, that had dropped to 10%. “That happened because we created an opportunity for more Americans, millions of Americans, to be able to achieve health insurance,” he said.
In Washington, D.C., the House of Representatives recently passed legislation that would reinstate the expanded tax credit with some compromises, Costa said, but it is unclear if the U.S. Senate will follow suit.
“With the federal government reducing its participation, it has an impact on whether or not people can stay under the insurance plan that they have,” he said. “In my congressional district, over 22,000 families would be directly impacted if we are not able to come to some agreement by the end of this month.”
The largest volume of cancellations statewide are among individuals and households that benefitted from the COVID-era expansion of the tax credits. “Those are our middle-income families that now have no financial support at all,” Soni told CVJC. “That’s what we used to call ‘the cliff,’ and they’re back on that cliff and they are canceling at double the rates” of those who still have some level of tax credit or subsidy to help pay for their insurance premiums.
Still, Soni and other health advocates said that many customers are still eligible for some level of financial assistance paying for their coverage, but have yet to enroll in Covered California.
“Here in Central California, including [Fresno], more than 200,000 residents are enrolled in Covered California, and over 90% of those enrollees receive financial assistance to help lower the cost of their monthly premiums,” said Annalisa Perea, a member of the Fresno City Council.
However, “an estimated 147,000 people in the Central Valley remain uninsured but are eligible for coverage, including about 61,000 who qualify for Covered California subsidies,” Perea added. “Too often, people assume coverage is out of reach, or believe they do not qualify, when in reality many are eligible for meaningful assistance that can significantly reduce monthly costs.”
Having health insurance “is about increasing access to care,” said Sandra Celedon, president and CEO of Fresno Building Healthy Communities, an advocacy organization. “That’s the goal. We know people who are uninsured delay care, leading to financial stress [and] higher medical costs.”
“Insured individuals are more likely to have a regular doctor … and access the necessary medications, leading to better management of chronic conditions,” Celadon added. “But we also need to make sure there’s consistent access to care that is supported by insurance, which is why we need consistent funding for the premium assistance that is available under Covered California.”
Soni, who continues to see patients as a physician with a board certification in internal medicine, told CVJC that before the Affordable Care Act, she would frequently encounter patients in hospital emergency rooms or her clinical practice with advanced diseases that could have been prevented with earlier care.
“I honestly don’t see that anymore,” she said. The Affordable Care Act “has been transformative for us in the state of California. We’re catching diseases earlier. We’re getting people into care. They’re getting specialty care and they’re living longer.”
With more people having health coverage through Covered California, “we do millions of cancer screenings each year, we are catching folks with earlier diagnoses, we are keeping people out of the emergency room [and] out of the hospital with the current structure that we have,” Soni said.
“I’m extremely worried about what happens, with the cancellations and the delays in care,” she added. “All of the safety net systems we had before, we don’t have anymore. … So I have my fingers and toes crossed that we might have action in Congress, but I’m extremely worried as a frontline provider.”
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.