How much more are ~440,000 NEW JERSEY ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at NEW JERSEY:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

It's important to note that all of the data below is based on plan selections during the Open Enrollment Period (OEP) only, which was only down slightly (less than 1%) vs. the 2025 OEP.

It doesn't include the more recent data from Get Covered NJ, which reported that actual effectuated enrollment as of April was actually down by 11.6% vs. a year earlier, or nearly 58,000 people. This means that actual current effectuated enrollment is down to around 440,000 statewide (likely even lower as of this writing).

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

As a result, the overall Actuarial Value of New Jersey enrollees dropped from 78.1% to 76.6% as the enrollees who weren't priced out of coverage entirely downgraded to worse plans: Enrollment in High CSR, Gold and even standard Silver plans have dropped substantially, while Bronze and Catastrophic enrollment have skyrocketed by over 60% apiece:

IMPORTANT: I only have detailed CSR category enrollment data for the 30 states hosted via the federal ACA exchange, HealthCare.Gov. Unfortunately, the Centers for Medicare & Medicaid Services (CMS) only provides total CSR enrollment for most of the 21 state-based exchanges (SBEs).

For these states, which includes New Jersey, I'm instead relying on rough estimates based on the percent of enrollees in the 100 - 150%, 150 - 200% and 200 - 250% FPL income brackets who selected Silver plans each year, which can be found in the 2025 & 2026 OEP State, Metal Level, and Enrollment Status Public Use Files (ZIP) from CMS.

These percentages, when converted into raw numbers, correspond fairly closely to the actual CSR category breakouts for FFM states (+ or - 5%), so they should be close enough for my purposes. I've also come up with rough estimates for the AI/AN CSR category based on comparisons of the percent of AI/AN CSR QHPs selected in FFM states to the percent of AI/AN residents within each state. This is less than 3.3% in every SBE state except for New Mexico.

Again, these are broad estimates only but should be reasonably accurate for this project.

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only).

It's also important to keep in mind that New Jersey is one of several states which provides their own supplemental premium subsidies to most enrollees. As best as I can figure, this amounted to an average of roughly $31 per enrollee per month last year and around $41 apiece per month this year:

Even with the scramble to "buy down" to cheaper, crappier coverage, average net premiums still shot up by ~61% on average, from $147/mo to $236/mo. That's over $1,000 more in premiums per enrollee per year.

Adding insult to injury: Downgrading to worse coverage has also resulted in out of pocket expenses jumping by an estimated ~19%, for a combined average healthcare cost increase of ~40%.

That's a total increase from ~$3,600 to nearly $5,000 per enrollee this year...or over $1,400 more apiece.

In addition, based on KFF's net data, average deductibles also increased by ~20% to ~$3,600 for single coverage this year, and the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: NEW MEXICO.