Alabama lost 95,000 people from its Affordable Care Act health plans this year — a 23% drop, the Alabama Reflector reports, citing a late-July analysis from KFF.

They didn't stop needing insurance. They got priced out. When the enhanced premium tax credits expired at the end of 2025, premiums rose an average of 58%.

This was not weather. It was a series of recorded votes, and every Alabamian can look up how their own member of Congress cast one.

Who loses coverage

Before the roll calls, it's worth being clear about who these 95,000 people are, because "ACA enrollees" is an abstraction and they are not.

Matt McGough, a KFF policy analyst, described the marketplace as a "last best option." Most enrollees are:

• small business owners
• people working multiple jobs that don't offer insurance
• retirees who aren't yet old enough for Medicare

"This is a group of people who, just by the nature of their work, don't have health insurance benefits. Every other potential door in our fragmented health insurance system is closed to them."

And in Alabama, that door is narrower than almost anywhere. Alabama is one of only ten states that never expanded Medicaid. The program here covers children, the elderly and people with disabilities almost exclusively. An adult with children qualifies only if the family makes 18% of the poverty level — $5,940 a year for a family of four.

So for a working Alabamian earning more than $5,940 and less than a comfortable living, the ACA marketplace wasn't one option among several. It was the only one.

Nationally, 49 states saw enrollment fall. The single exception was New Mexico, which spent its own state money to replace the lost federal help. Alabama did not.

The Senate vote: Tommy Tuberville

On December 11, 2025, the Senate voted on whether to even begin debating S. 3385, a bill to extend the expiring tax credits.

It needed 60 votes to proceed. It got 51. The motion was rejected and the bill died without ever receiving an up-or-down vote.

Tommy Tuberville voted no, according to the official Senate roll call.

Tuberville is now running for governor of Alabama — asking to lead the state whose hospitals absorb the cost of the uninsured he helped create.

The House vote: the bill with the reassuring name

Six days later, on December 17, 2025, House Republicans passed their own health bill and called it the "Lower Health Care Premiums for All Americans Act." It passed 216–211.

It does not extend the enhanced premium tax credits. As the Association of American Medical Colleges documented, the bill contains no extension at all. Instead it loosens the rules on "association health plans," creates a pre-tax account for employers, and lets employers buy stop-loss insurance.

Association health plans are cheaper largely because they don't have to cover everything a normal plan covers.

So the name says "lower health care premiums." The bill leaves the premium increase exactly where it is.

Here is how Alabama's delegation voted, per the official House roll call:

Four Alabama Republicans voted for the bill that doesn't extend the credits. Gary Palmer did not vote at all — on the House's only health care bill of that December, with his own constituents' premiums about to jump 58%.

Alabama's two Democrats, Terri Sewell and Shomari Figures, voted no.

What it does to the hospitals

The damage doesn't stop with the 95,000. Debbie Smith, who directs Cover Alabama at Alabama Arise, explained the chain reaction:

"What that means is more people are going to the ER without health insurance coverage. The hospital has to pick up that cost, and that makes it more likely for that hospital to not be able to absorb it, and possibly have to get rid of services at that hospital, or even shut down."

That isn't hypothetical in Alabama. Hospitals here are already struggling, and some have closed in the past year. Jackson Hospital in Montgomery was set to close in July after filing for bankruptcy — a safety-net hospital in a state that never expanded Medicaid. It survived only by reaching an agreement with Blue Cross and Blue Shield of Alabama. (It's the same hospital a Georgia billionaire lent $35 million at 14% interest and called "venture philanthropy.")

Every uninsured Alabamian who walks into an emergency room is a bill somebody pays. Right now that somebody is a hospital system already running on fumes.

"They knew in advance"

Smith's summary is the fairest description of what happened:

"This was a policy choice by Congress to let these extra tax credits expire... For Congress to just let these tax credits expire and allow that many people to lose their health coverage, they knew in advance that this would cause a lot of people across the country and here in Alabama to lose their health insurance."

That's the part worth holding onto. Nobody was surprised. KFF's March poll had already found that 17% of returning enrollees weren't confident they could afford their 2026 premiums. The projections were published. The votes happened anyway.

Alabama is not alone, and that's the point

We've now written this same story about state after state:

• 197 Republicans voted to spike health insurance premiums — the full national tally of both votes.
• 14,441 Arkansans lost Obamacare and their Republicans let it happen.
• In Wisconsin, 45,000 people lost coverage while their congressman defended the cuts.

Alabama's 95,000 is among the worst of them, in the state least equipped to absorb it, because there's no expanded Medicaid underneath to catch anyone.

For the fuller accounting of what this delegation costs the state, see what Alabama's Republicans in Congress are costing you.

What to ask them

The tax credits may come back in some form — McGough notes it's "really hard for the government to offer a benefit to someone and then actually take it away," and it will be an issue through the midterms.

Until then, Alabamians have five specific questions for five specific people:

• To Aderholt, Moore, Rogers and Strong: you voted for a bill named "Lower Health Care Premiums." Premiums went up 58%. What exactly did your vote lower?
• To Palmer: where were you?
• To Tuberville: you blocked the extension, and now you want to be governor. What's your plan for the 95,000?

Alabama deserves representatives who read the bill, not just the title.

Sources

• Alabama Obamacare enrollment drops 23% after tax credits expire — Anna Barrett, Alabama Reflector, August 19, 2026.
• Senate Roll Call Vote 644, S. 3385 cloture, December 11, 2025
• House Roll Call 349, H.R. 6703, December 17, 2025
• House Passes Health Care Bill Without Extending Enhanced ACA Subsidies — AAMC