Oregon's health insurance marketplace enrollment fell to 118,372 for 2026 — a drop of more than 21,000 enrollees (approximately 15-16.5%) and the 7th largest decline nationally — as the expiration of enhanced ACA premium subsidies delivered sticker shock across the state.

The driver is straightforward: the enhanced premium tax credits enacted during COVID in 2021 expired December 31, 2025. In 2025, roughly 80% of Oregon exchange enrollees qualified for subsidies averaging $531 per month. For 2026, that share dropped to about 60%, and the income cap returned to 400% of the federal poverty level. Individuals between 200-400% FPL face premium increases of $90-$165 per month. Oregon's average pre-subsidy rate increase is under 10% — better than the national average of 25% — but insurers added an additional 4% specifically for the subsidy expiration. Nationally, marketplace premium payments are projected to jump 114% on average.

The enrollment decline creates a cascading effect across Oregon's healthcare system. Fewer insured patients mean higher uncompensated care costs for hospitals already under financial pressure — Providence lost $256 million in Q1 2025 alone, and Bay Area Hospital is fighting for survival. For practice owners, the math is simple: patients who dropped marketplace coverage either go uninsured (increasing bad debt), shift to OHP if eligible (lower reimbursement), or delay care entirely (sicker patients, higher acuity). CCOs should watch for an uptick in new OHP enrollment from marketplace dropouts — a phenomenon that could stress an already-stretched Medicaid system.

Watch for the 2027 rate filing cycle this summer, which will reveal whether insurers adjust for the smaller, potentially sicker risk pool.