How much more are ARKANSAS 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.

Note that healthcare policy/data firm KFF published a new analysis of actual 2026 ACA enrollment and determined that average ACA Marketplace deductibles actually increased by a whopping 37% (or $1,027 per person) to a record high of $3,786 in 2026...which only serves to underscore the entire point of the very out of pocket cost analysis project you're reading right now!

I've been able to utilize KFF's data to estimate the average deductible for every state in both 2025 & 2026 as well, and have decided to start adding to those to the bar graphs.

Let's take a look at ARKANSAS.

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by raw metal level:

On the surface, besides Arkansas seeing ~6,300 fewer people sign up for coverage out of the gate, this makes it look like the average Actuarial Value (AV) increased slightly, from 67.9% in 2025 to 69.9% in 2026. If so, this would mean that average plan quality improved overall for the ~160,000 Arkansans who signed up.

The reason for this is that Arkansas is one of just three states (along with Illinois and Washington) which newly-implemented robust Premium Alignment pricing for 2026, which resulted in GOLD plans being priced well below SILVER plans on average. As a result, while enrollment in Silver plans dropped by more than half, GOLD enrollment more than QUINTRIPLED from less than 8,000 to more than 50,000 people.

HOWEVER, as I explain at length in the original post, this is still misleading since a huge chunk of ACA enrollees are generally low-income enough to be eligible for Cost Sharing Reduction (CSR) assistance, which boosts Silver plans up to Platinum levels of AV for most CSR enrollees.

When I adjust for that, the weighted average AV jumps for both years...but instead of the average AV increasing by 2 points, it actually dropped a bit, from 79.9% to 76.6%. This is a less dramatic drop than most other states, but it's still a bit disappointing...although the impact on net premiums is still pretty positive (see below).

The problem is that while both standard Silver (70% AV) and CSR 73 Silver (73% AV) dropped substantially, so did the CSR Silver plans with better than Gold coverage (CSR 87 & 94):

In any event, 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 (which, as I stated in the original post, can vary widely by carrier and year, so this should be considered a very broad average only), which looks like so:

(Note: I've decided to stop including the alternate 85% MLR model going forward since it makes the table more confusing and doesn't really change the dollar amounts by that much.)

In Arkansas, the ~160,000 residents who did sign up for ACA exchange coverage saw their net premiums jump by 31% on average...which would be devastating most years but which is actually modest compared to most states this year. Credit for this relatively "mild" average rate hike (from ~$1,488 to ~$1,944 per year on average) can be chalked up largely to the state's embrace of Premium Alignment pricing.

At the same time, however, Arkansans are also being hit with what appears to be a 73% average increase in out of pocket costs...jumping from around $1,500 last year to over $2,600 this year.

Combined, on average, Arkansas enrollees are paying an additional ~$1,500 in healthcare costs this year...a 51% hike to around ~$4,400 per enrollee.

In short, thanks to robust Premium Alignment being put into place, Arkansas enrollees are seeing their net premiums jump by far less than most states (only 5 other states saw a lower percent hike year over year), but is still seeing out of pocket costs increase by among the highest in the country (only 3 other states jumped by more).

In addition, based on KFF's net data, average deductibles also jumped by 24% to over $3,300 for single coverage this year, and of course 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: CALIFORNIA!