How much more are ~370,000 VIRGINIA 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 recently it was confirmed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, 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 February 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 plana 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 VIRGINIA:

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

Like most states, Virginia has seen enrollment plummet across most income brackets, especially among enrollees who earn less than 100% of the Federal Poverty Level (FPL), which is due to the Trump Regime eliminating subsidy eligibility for around 1.4 million low-income legally residing non-citizens.

Overall, plan selections have dropped by 4.8%, or nearly 19,000 people versus OEP 2025.

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 shown below, the ~370,000 Virginians who weren't completely priced out of the market were forced to "buy down" to worse plans with higher deductibles & other out of pocket expenses, worse provider networks and so on in order partially mitigate the massive rate hikes.

As a result, the average actuarial value for enrollees dropped from 75.5% to 74.2%, which isn't that bad overall under the circumstances.

Still, 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), which looks like so:

Average net premiums still jumped by 59% year over year from $135/month to $215/month on average, while by my best estimates, average out of pocket expenses shot up by 26% as well.

Combine the two and you're looking at an estimated per enrollee healthcare expense hike of ~43%, or over $1,300 apiece this year.

In addition, based on KFF's net data, average deductibles also increased by ~16% to over $3,900 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: WASHINGTON.