How much more are ~260,000 OoooooKLAHOMA 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.

Let's look at OKLAHOMA:

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

It's a bloodbath, as the numbers have dropped at every single income level, plummeted by 15% overall and by as much as 72% in some income brackets.

That's over 46,000 Oklahomans who lost their ACA healthcare coverage before the year even began...and this number is almost certainly far higher as of this writing.

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.

Enrollment in Gold and CSR Silver plans have dropped by as much as 50% or more...while enrollment in high deductible standard Silver, Bronze and Catastrophic plans have gone through the roof.

Overall, the average Actuarial Value has dropped from 80.7% to 75.7%:

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:

Even with the scramble to "buy down" to cheaper, crappier coverage, average net premiums for the ~469,000 who did manage to select plans during Open Enrollment still MORE THAN DOUBLED ON AVERAGE, from $78/mo to $161/mo. That's nearly ~$1,000 more in premiums per enrollee per year.

Adding to the depressing news: Downgrading to worse coverage has also resulted in out of pocket expenses jumping by an estimated ~59%, for a combined average healthcare cost increase of ~78%.

That's a total increase from around $2,300 last year to over ~$4,100 per enrollee this year...or over $1,800 more apiece.

In addition, based on KFF's net data, average deductibles also increased by ~50% to ~$4,000 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: OREGON.