New enrollments in Covered California, the state’s health insurance marketplace under the Affordable Care Act, are down by nearly one third over the past year across the San Joaquin Valley following the expiration of enhanced tax credits that helped subsidize the cost of coverage for buyers.
Cancellation of coverage by people who were previously enrolled, particularly middle-income individuals and households who benefited from the expanded COVID-era subsidies, are also up as people encounter higher out-of-pocket costs for premiums.
Almost 2 million California residents purchased health insurance through Covered California in 2025. 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. Under Covered California, people can purchase health insurance policies at different levels of coverage from an array of companies.
In the San Joaquin Valley (Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus and Tulare counties), just over 22,000 people signed up for new Covered California plans during the open enrollment period for 2026, after the expiration of the Enhanced Premium Tax Credits on Dec. 31. That’s down 32% compared to 2025 open enrollment, when almost 32,400 people signed up.
The enhanced subsidies enacted during the COVID-19 pandemic to increase the affordability of the health plans for middle-income members expired at the end of 2025 with no congressional action to continue the relief. What that means is that the out-of-pocket cost for premiums increased substantially for members, especially those in middle-income families, according to a county-by-county analysis by the Public Policy Institute of California.
“During the pandemic, Congress temporarily increased subsidy amounts and expanded eligibility to middle-income households – those earning between 400% and 600% of the federal poverty level (about $62,000 to $94,000 for an individual or $128,000 to $193,000 for a family of four),” analysts Shannon McConville and Shalini Mustala wrote in the PPIC report.
The PPIC estimated the average annual premium for middle-income enrollees increased by more than $5,200 per person in Fresno County and more than $10,000 per person in Merced County.
In the San Joaquin Valley, Covered California reported that more than 161,000 Covered California enrollees benefit from some level of tax credit, mostly from the original subsidies for lower-income households included when the Affordable Care Act became law. The expiration of the expanded tax credits, however, leaves those in the middle-income range to largely bear the entire cost of premiums without any subsidy. Covered California reported that more than 17,200 members in the Valley are unsubsidized.