NEW YORK — Over the past year, states nationwide have experienced significant reductions in the number of individuals covered by the Affordable Care Act, with Ohio and Oklahoma each losing about one-third of their participants. This is according to new federal data, which offers the first comprehensive 50-state analysis of enrollment declines following the expiration of enhanced subsidies in January.
The data, released by the Trump administration in late June and initially reported by The Associated Press, highlights a reduction of approximately 2.6 million Americans with Obamacare plans in February compared to the previous year.
This data not only tracks how many individuals enrolled or were automatically re-enrolled in 2026 but also accounts for those who paid their initial monthly premiums to maintain coverage. Cynthia Cox, a vice president and director of the ACA program at the nonprofit health care research group KFF, who reviewed the data, noted that it includes individuals who were retroactively removed from coverage after the conclusion of a nonpayment grace period.
“This is the first instance of state-level data revealing the extent of the decline in ACA marketplace enrollment,” Cox remarked. “While it aligns with our expectations, the data shows a substantial decrease in the number of people with ACA coverage.”
Health care affordability is a central issue to voters
Health analysts have been monitoring ACA enrollment changes closely since the end of the enhanced premium tax credits, which led many Americans to face doubled or tripled monthly health insurance costs, prompting some to drop coverage. These subsidies were a contentious issue in Congress last fall, with both Democrats and some Republicans pushing for their renewal.
As health insurance costs rise across ACA and other programs, voters indicate that affordability is a major concern in the upcoming November elections.
A report released last week by the U.S. Department of Health and Human Services suggested that the drastic enrollment decrease this year might be due to a federal crackdown on fraudulent or “phantom” enrollments. However, analysts suggest it is more likely due to the Jan. 1 expiration of federal subsidies and other changes, including stricter requirements for immigrants accessing subsidized plans.
Ohio, Oklahoma, and Arizona experienced the greatest declines
An analysis by AP reveals that Ohio and Oklahoma each saw a reduction of over 32% in ACA enrollment over the past year, losing larger proportions of their insured populations than any other states.
Following closely, with losses exceeding a quarter of their enrollees, were Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri.
Florida, which heavily relies on ACA insurance due to its lack of Medicaid expansion and a significant number of gig workers and entrepreneurs, still has nearly 4 million residents in the marketplace, more than any other state. However, it also experienced the largest number of enrollees dropping coverage this year — approximately 443,000.
The data does not provide information on whether those who dropped ACA health insurance this year found alternative coverage. Some may have obtained insurance through employer plans or other means. However, Cox noted that most people leaving the marketplace are likely uninsured, as it often serves as a “last resort” for those not eligible for other coverage.
States that saw the largest enrollment declines were often the same ones that experienced significant enrollment increases when enhanced subsidies were introduced during the COVID-19 pandemic. Cox indicated that this trend is expected, as these states had many individuals who joined because the enhanced subsidies made coverage more affordable.
New Mexico was the only state to report an increase in its insured population, with a 14% rise in enrollees compared to the previous year. It was the sole state to fully replace the lost federal subsidies with its own funding.
Federal marketplace states faced the largest enrollment declines
Approximately three out of five states use the federal marketplace Healthcare.gov, while the remainder operates their own state-based marketplaces for ACA insurance.
The new data indicates that states utilizing the federal marketplace experienced larger enrollment losses than those with state-based exchanges.
This may be due to many states with their own marketplaces taking measures to alleviate costs for residents after the enhanced subsidies ended in January.
New Mexico, which saw significant enrollment gains, exemplifies this approach. In a special legislative session last fall, state lawmakers approved a plan to use state funds to compensate for the missing subsidies through mid-2026. In March, the governor signed a bill to extend this support through mid-2027.
