Significant Decline in ACA Enrollment Across States
Recent data reveals a sharp decline in Affordable Care Act (ACA) enrollments over the past year across the United States. Ohio and Oklahoma each experienced a decrease of nearly one-third in enrollees. This information, released by the Trump administration, shows a nationwide reduction of approximately 2.6 million individuals with Obamacare plans as of February 2026, compared to the previous year.
The decline in coverage was influenced by the expiration of enhanced federal subsidies this January. These subsidies had previously made health insurance more affordable for many Americans. Cynthia Cox, vice president and director of the ACA program at KFF, reviewed the data. She noted that this comprehensive state-level data highlights a significant reduction in ACA marketplace enrollment.
Healthcare affordability remains a critical concern for voters, with rising insurance costs impacting many. The expiration of premium tax credits has led to increased monthly health insurance fees, compelling some to drop coverage entirely. While the U.S. Department of Health and Human Services attributed the drop partly to efforts against fraudulent enrollment, analysts suggest the end of federal subsidies played a more critical role.
States with Major Enrollment Declines
Ohio and Oklahoma reported the largest declines, losing over 32% of enrollees. Other states, including Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri, also saw more than a 25% decrease. Florida, despite having the highest number of ACA enrollees, saw approximately 443,000 individuals drop coverage, the largest numerical decline.
Many who left the ACA marketplace likely remain uninsured. Cox noted that the ACA often serves as a last resort for those ineligible for other health coverage options.
New Mexico’s Unique Approach
New Mexico was the sole state to increase its ACA enrollment by approximately 14%. The state achieved this by using its own funds to replace lost federal subsidies. Legislation passed last fall allows the state to continue supporting enrollees through 2027. This proactive measure has supported ACA coverage in New Mexico effectively.
Impact of Federal and State Marketplaces
States using the federal marketplace Healthcare.gov generally experienced greater enrollment losses than those operating their own exchanges. This disparity suggests that state-based marketplaces effectively mitigated subsidy expiration impacts. New Mexico stands as a prime example of a state taking significant action to maintain ACA coverage.
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