As health insurance premiums rise and enrollment declines, what’s the impact on Washtenaw County?

As federal health insurance tax credits have expired and insurance subsidy eligibility has narrowed, there are already signs that fewer Washtenaw County residents are getting insured – and larger effects on the county’s residents, health care system, and small businesses are still to come.

Affordable Care Act (ACA) enhanced premium tax credits for the Health Insurance Marketplace expired at the end of last year. Meanwhile, H.R. 1 — known as the “One Big Beautiful Bill Act” — has barred permanent U.S. residents and work-authorized individuals earning under 100% of the federal poverty level ($15,650 annually for an individual) from health care subsidies.

Marketplace enrollment has already decreased in Michigan. Statewide, enrollment fell from 531,083 in 2025 to 497,064 in 2026, a decrease of approximately 6.4%, according to federal data. That change suggests a coming turnaround for Michigan’s uninsured rate, which had fallen significantly since the ACA became law. A recent report from the University of Michigan Center for Health and Research Transformation found that the state’s uninsured rate fell from 11.8% in 2008 to 5.2% in 2024.

At the county level, the Washtenaw Health Project (WHP) helps people access the health care they need, including navigating the insurance marketplace. WHP assisted 551 individuals with marketplace coverage enrollment for 2026 — down from 804 enrollees the previous year, a 31.5% decrease. The average premium individuals are paying to receive insurance through the marketplace has more than doubled.

“This has created a new gap,” says Jeremy Lapedis, executive director of WHP and the Washtenaw Health Plan. “People who make less than 200% of the federal poverty level were receiving the most in subsidies.”

“Some people may have chosen to bite the bullet and gotten coverage,” he adds. “Some may have signed up for bronze plans. Some may be avoiding health care. Some people are enrolling in coverage and are going to cancel later in the year. Not many of these options are great if you have a chronic condition or face an emergency.”

More people going without insurance will also have larger negative effects in Washtenaw County and beyond. 

“When people go without insurance, that raises the costs for everyone because hospitals need to cover them,” Lapedis says. “This is a system that affects all of us.”

Lapedis has also heard from employers, including those who run small businesses and nonprofits, who are unable to offer plans. 

“Many employees used to go to the marketplace for their insurance and now they’re worried about retaining employees,” he says.

Andy LaBarre, executive vice president and director of government relations for the A2Y Regional Chamber, echoes that sentiment, asserting that “Small businesses are hurt by the lack of ACA subsidies.”

“These subsidies benefited both the employee and the employer,” he says. “Right now, there’s a sense that there’s probably not going to be any change unless it gets worse. We’ll need to get into the second or third quarter to really see what happens.”

LaBarre also notes that the health care disruptions aren’t happening in isolation.

“The biggest thing is that in the last 14 months, there’s not stability the way businesses would like it,” he says. “With all the things that are happening at such a fast pace, it’s hard to plan. The pace of change is so fast that when you combine it with issues around cost and health care impacts, that’s a lot to throw at a small business.”

Whether individuals are avoiding medical care as a result, and the broader impact if so, has yet to be determined.

“A lot of what we do in local health departments is make sure people have equitable access to health care,” says Jimena Loveluck, health officer with the Washtenaw County Health Department. “We know that because of the impact of the end of these subsidies, people are choosing to go without insurance, and preventive services are the first things people give up, unfortunately. We want to make sure people still get preventive services and know they can get them at the health department.”

This includes immunizations for communicable diseases such as measles and the flu. Even if you have private insurance, being aware of the situation is important.

“These subsidy and Medicaid changes will have an impact on all of us, even people with private insurance,” Loveluck says. “The increased cost to health systems gets dispersed to others that rely on private insurance, so it’s not only an impact on people who rely on subsidies or who have Medicaid.”