(VIRGINIA MERCURY) – What might be pocket change to some can be a breaking point for others — forcing tough choices between health insurance and everyday essentials.

As Virginians, and Americans nationwide, face premium spikes in the Affordable Care Act marketplace after Congress failed to renew subsidies, many are weighing the cost of coverage against paying rent or mortgages, making car payments or paying for public transit, and buying groceries.

A new federal report indicates 1.2 million fewer Americans signed up for ACA insurance during the most recent open enrollment period nationwide.

In Virginia, about 33,000 people have dropped off, State Health Exchange Director Keven Patchett said at a forum with the State Corporation Commission.

“That’s the biggest drop-off in the first quarter that we’ve seen,” he told SCC members of the State Corporation Commission at Thursday’s event in downtown Richmond.

Overall, an estimated 100,000 Virginians who have utilized the subsidies are expected to be affected — either by enduring higher premiums, shifting to lower-tier coverage, or foregoing the insurance altogether.

The total ACA drop-offs in the commonwealth remains a moving target for several reasons, Patchett said, but more clarity could emerge in the coming days or weeks.

Read more on virginiamercury.com