ACA enrollment fell by 2.6 million after subsidy expiration
Federal data reviewed by the AP shows sharp state-level drops in Obamacare coverage after enhanced premium tax credits ended in January.
By Maya Lindqvist · Senior Technology Correspondent
3 min read
About 2.6 million fewer Americans had Affordable Care Act marketplace coverage in February than a year earlier, according to federal data analyzed by The Associated Press. The decline gives the first full state-by-state view of the drop after enhanced federal premium subsidies expired in January, at a time when health costs are a central issue for voters ahead of the November midterms.
The data, posted in late June by the Trump administration, measures people who not only selected or were automatically placed into 2026 plans but also paid their first monthly premiums, according to Cynthia Cox, vice president and director of the ACA program at KFF. Cox told the AP the figures also reflect removals after grace periods for nonpayment ended.
“This is the first time we’ve seen state-level data that shows how much ACA marketplace enrollment truly fell,” Cox said, according to the AP. She said the scale of the decline matched expectations but showed a steep reduction in people covered through ACA plans.
Subsidy lapse drove higher costs
Health policy analysts have tracked ACA enrollment closely since enhanced premium tax credits ended on Jan. 1. According to the AP, the expiration caused monthly premiums for many consumers to double or triple, leading some people to drop coverage.
The subsidies had been the subject of a fight in Congress last fall, the AP reported, with Democrats and some Republicans pressing to extend them. Health insurance costs have also been rising across ACA and other coverage programs as voters identify affordability as a leading concern before the elections.
In a report released last week, the U.S. Department of Health and Human Services said this year’s enrollment decline could be tied to a federal crackdown on fraudulent or “phantom” enrollment. Analysts cited by the AP said the drop was more likely linked to the subsidy expiration and other policy changes, including tighter rules on which immigrants could receive subsidized plans.
Mike Rhoads, deputy commissioner of life and health at the Oklahoma Insurance Department, told the AP that anti-fraud efforts contributed to the decline in ACA enrollment. He said affordability was the bigger force in Oklahoma and expected the pressure to persist because insurers are projected to raise rates again next year.
Largest declines hit several federal marketplace states
Ohio and Oklahoma each lost more than 32% of their ACA enrollees from a year earlier, according to the AP analysis, the largest percentage declines of any state. Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri each lost more than one-fourth of their covered ACA populations.
Florida remained the state with the most marketplace enrollees, with nearly 4 million people covered, according to the AP. It also recorded the largest numeric drop, with about 443,000 fewer enrollees this year.
The federal data does not show whether people who left ACA plans obtained other coverage. Cox told the AP that some likely moved to employer plans or other options, but she said most people who leave the marketplace are probably uninsured because ACA plans often serve people who lack another route to coverage.
States using the federal Healthcare.gov marketplace generally lost larger shares of enrollees than states that run their own exchanges, according to the AP. About three in five states use the federal marketplace.
New Mexico was the only state to increase its covered ACA population, gaining about 14%, according to the AP. State lawmakers approved funding to replace the lost federal subsidies through mid-2026, and Gov. Michelle Lujan Grisham later signed legislation extending that support through mid-2027.
Tim Fowler, public relations coordinator for the New Mexico Health Care Authority, told the AP the enrollment increase was tied to the state’s healthcare affordability fund. He said New Mexico’s goal is for health insurance to protect residents from medical debt rather than create it.
This story draws on original reporting from Fortune.