Despite handwringing over enhanced federal subsidies going away for many Coloradans enrolled in health insurance on the state’s marketplace, officials reported Friday just a 2% enrollment dip.

More than 277,000 Coloradans enrolled in health insurance through the Affordable Care Act — colloquially known as “Obamacare.”

The decline followed five years of consecutive growth, state officials said.

“On one hand, it’s encouraging to see enrollment remain relatively steady, with only a slight dip, and to see so many people receive meaningful financial assistance,” Kevin Patterson, the CEO for Connect for Health Colorado, said in a statement.

Connect for Health Colorado manages the state’s health insurance exchange under the ACA.

Patterson credited, in part, the money Colorado lawmakers approved during special session last year for absorbing some of the expected increase. Without having done so, the 101% average increase would have been 147%, Patterson has said.

“On the other hand, it’s deeply troubling that a record number of people are canceling their plans because they simply can’t afford their monthly payments, or are being forced to choose between health care and basic necessities like housing and food. Without federal enhanced Premium Tax Credits, this alarming trend is, sadly, emerging across the country.”

Notwithstanding the subsidy cuts, nearly one in seven Coloradans received financial help to help lower their monthly premium costs.

And while the enrollment dip was less than expected, state officials still warn the expiration of federal subsidies for many Coloradans could be among the forces driving an 83% increase in the number of canceled plans compared to this time last year.

Experts had predicted an untold number of people would forgo health insurance.

The Colorado Division of Insurance had estimated 75,000 Coloradans would lose their health care coverage with the premium increases.

While officials believe most individuals who forgo obtaining insurance will be relatively healthy and those with chronic conditions, who can afford the increase, will likely stay insured. The uninsured are expected to turn to hospital emergency departments for care.

And that will drive up the cost of care for everyone.

“When patients forgo coverage, they delay or skip care, and hospitals see more severe cases, rising uncompensated costs, overuse of the hospital emergency department, and added strain on an already stretched health care system,” Cara Welch, a spokesperson for the Colorado Hospital Association, has said.

Welch pointed to skyrocketing charity care costs, which have doubled since 2019, according to the state Department of Health Care Policy and Financing.

“This underscores the growing strain on hospitals as more Coloradans lose access to affordable coverage,” Welch has said. “This won’t be just a rural problem or an urban problem — it’s a Colorado problem.”

Five years ago, Congress adopted the American Rescue Plan Act in response to the COVID-19 pandemic which, among other provisions, temporarily expanded eligibility for the premium tax credits for 2021 and 2022.

Notably, the law eliminated the income limit of 400% of the federal poverty level, thereby allowing more Americans to qualify, and provided larger subsidies compared to the original ACA.

These enhanced tax credits were extended in 2022 for another three years and sunset on Jan. 1.

About 225,000 Coloradans depend on these tax credits to afford health care coverage on the marketplace.

Roughly 24 million Americans are covered under the ACA.

“These premium increases are going to create impossible decisions for families across the state,” Colorado Insurance Commissioner Michael Conway has said.

Premiums elsewhere in the country are expected to be higher.

The average premium increase nationally is 114% compared to 101% in Colorado.

Supporters of extending the enhanced subsidies have argued that letting it expire would mean millions of Americans would lose health coverage, while critics said they were meant to be temporary and that continuing them would subsidize higher-income earners at a significant cost to taxpayers.

In October, Democrats in the U.S. Senate blocked a continuing resolution to fund the government because the Republican appropriations bill did not include extending these enhanced subsidies, which triggered the longest shutdown in American history.