Georgia's health insurance marketplace has lost hundreds of thousands of enrollees since enhanced federal subsidies expired at the end of 2025, and the fallout is landing hardest on rural safety-net providers already stretched thin. In Stephens County, Open Arms Clinic — a free medical clinic that treats uninsured adults — says it may have to close its doors next year if it cannot secure funding before December.
Georgia's ACA enrollment fell 37%, from 1.5 million people in January 2025 to 950,000 as of April 17, 2026, according to The Current. A later report from the same outlet put Georgia Access enrollment at about 900,000 people, a discrepancy the dossier does not resolve. The decline follows the December 31, 2025 sunset of pandemic-era enhanced subsidies that had made marketplace plans more affordable for years.
Open Arms Clinic, which describes itself as a free medical clinic dedicated to providing adult primary care and medications to the underserved and uninsured of Stephens County, is funded entirely by individual and public donations, according to the clinic's own site. It serves residents who are uninsured and cannot afford coverage, and applicants who are accepted typically wait about a week before receiving an appointment, per the clinic's services page. Local outlet The Toccoa Record reports the clinic may have to close its arms next year if it does not acquire funding before December.
Premiums and Deductibles Climbed After the Subsidy Cliff
The squeeze on uninsured Georgians arrived alongside rising costs for those who kept their coverage. Nationally, premium payments for people who signed up for 2026 ACA coverage increased by an average of 58%, from $113 to $178 per month, according to KFF. Average marketplace deductibles climbed 37%, or $1,027 per person, to a record $3,786 in 2026, the same analysis found. A KFF survey also found that 9% of 2025 marketplace enrollees had become uninsured by late February or early March 2026, though The Current notes there is currently no data showing whether Georgians who dropped marketplace coverage are now completely uninsured or found insurance elsewhere.
Georgia is not alone in losing marketplace enrollees. Every state except New Mexico saw a drop in ACA Marketplace enrollment from 2025 to 2026, KFF reports. Nationally, average monthly effectuated enrollment is projected to fall to about 17.5 million people in 2026, down from 22.3 million in 2025. The marketplace could keep shrinking as healthier enrollees leave, potentially pushing premiums even higher.
Proposed 2027 Rate Hikes Still Not Final
Georgia's 2027 ACA premiums are on track to rise by as much as 20% or more, based on proposed prices filed using late-August data, The Current reported. Those figures are not final, and the eventual rate hikes and their effect on enrollment remain unsettled questions.
Rural Hospitals Already Absorbing Losses
Georgia's health sector was expected to lose more than $3.5 billion in 2026 because of the expiring subsidies, a projected hit that The Current says would rank among the three largest in the nation, behind only Florida and Texas. Georgia has traditionally had one of the three worst uninsured rates in the country, alongside Texas and Oklahoma, per the same report.
Twenty of Georgia's 71 rural hospitals are now considered at risk of closure, including 10 classified as at immediate risk, according to a report cited by FOX 5 Atlanta. That report also found more than one-third of rural hospitals nationwide reported overall financial losses in 2023 and 2024, and nearly half operate at a loss when providing patient care. Rural hospitals generally carry high levels of uncompensated care and too few privately insured patients to stay financially stable, KFF Health News has reported.
Counts of past Georgia rural hospital closures vary by source: FOX 5 Atlanta reports nine rural hospitals in Georgia have closed since 2005, while KFF Health News separately reported that eight had shut down in Georgia over the preceding decade as of 2021. Nationally, nearly 200 rural hospitals have closed over the last two decades, and a 2020 Chartis analysis identified 453 rural hospitals as vulnerable to closure.
As first reported by The Atlanta Journal-Constitution, the strain on Georgia's rural health system is unfolding as thousands of residents lose insurance coverage statewide. For clinics like Open Arms, the math is simple: as marketplace coverage becomes less accessible and more expensive, free and low-cost providers are left absorbing more patients with fewer resources to do it.
