NEW YORK — Over the past year, states across the country have seen significant declines in the number of people eligible for the Affordable Care Act, with Ohio and Oklahoma each losing nearly a third of their enrollees, according to new federal data that provides the first complete 50-state breakdown of the sharp decline in enrollment as enhanced subsidies expire in January.
The data, released by the Trump administration in late June and first reported by The Associated Press, reveals how about 2.6 million fewer Americans had Obamacare plans in February compared to the same time last year, due to changes in each state’s insured population.
The dataset records not only the number of people who signed up for a plan or were automatically re-enrolled in a plan in 2026, but also the number of people who paid their first monthly premium to continue their coverage, said Cynthia Cox, vice president and ACA program director at the healthcare research nonprofit KFF, which reviewed the dataset. He said this includes people who were retroactively removed from coverage after the grace period for non-payment ended.
“This is the first time we’ve seen state-level data showing how much ACA Marketplace enrollment has actually declined,” Cox said. “This is consistent with our expectations, but indicates a very steep decline in ACA enrollment.”
Health insurance affordability is a central issue for voters
Health analysts have been closely monitoring changes in ACA enrollment since the expiration of the so-called enhanced premium tax credit, which doubled or tripled monthly health insurance premiums for many Americans and forced some to abandon coverage altogether. The subsidies were at the center of a bitter fight in Congress last fall, with Democrats and some Republicans seeking to renew them.
How many Americans can afford quality health care? New poll finds that number is decreasing
Health insurance costs are rising across the ACA and other health insurance programs as voters say affordability is one of their top concerns in the upcoming November election.
In a report released last week, the U.S. Department of Health and Human Services suggested that this year’s large drop in enrollment could be attributed to a federal crackdown on fraudulent or “fictitious” admissions. But analysts say this is likely related to other changes, including the Jan. 1 expiration of federal aid and stricter requirements for immigrants to qualify for subsidized plans.
The largest declines were seen in Ohio, Oklahoma, and Arizona.
An analysis of data by the Associated Press found that Ohio and Oklahoma each saw their ACA enrollment decline by more than 32% over the past year. These states lost a larger share of their eligible population than any other state.
It was followed by Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri, which lost more than a quarter of their enrollment.
Florida, a state that relies heavily on ACA insurance in part because it did not expand Medicaid and has a large population of gig workers and entrepreneurs, still has more residents living in the marketplace than any other state, nearly 4 million. However, this year saw the highest number of participants, with approximately 443,000 people dropping their insurance coverage.
STAT Plus: U.S. health spending soars in 2025 thanks to GLP-1 use and more medical care
The data does not indicate whether people who dropped their ACA health insurance this year found other coverage, but some of them may have gotten coverage through employer plans or other options. But Cox said most people who leave the marketplace are likely to go without insurance. That’s because marketplaces are typically a “last resort” for people who don’t qualify elsewhere to get health insurance.
Some of the states that saw the largest declines in enrollment were the same states that saw the largest increases in enrollment after the federal government introduced enhanced subsidies during the coronavirus pandemic. Cox said this is not surprising, since those states likely had large numbers of enrollees simply because enhanced subsidies made premiums much more affordable.
Only one state saw an increase in its population. In New Mexico, enrollment in government health insurance programs increased by about 14% compared to the same time last year. The state was the only state in the nation to replace lost federal aid entirely with its own funds.
States with federal markets saw the largest declines in enrollment.
Approximately three out of five states use the federal marketplace, Healthcare.gov, and the remaining states operate their own state-based marketplaces for ACA insurance.
New data shows that states in the federal market are losing a larger share of enrollment overall than states with state-based exchanges.
One reason for that may be that many states with their own markets took steps to offset costs for their residents when enhanced subsidies expired in January.
New Mexico, where enrollment has increased by double digits, is the most extreme example. During a special session last fall, state lawmakers approved a plan to use state funds to fill the funding gap through mid-2026. The governor signed a bill in March that would continue to cover the difference until mid-2027.
