The number of people covered by the Affordable Care Act (ACA) has significantly dropped across the United States. Ohio and Oklahoma have each seen nearly a third of enrollees leave, according to new federal data. The data provides a comprehensive 50-state breakdown of enrollment declines after the enhanced subsidies ended in January. Around 2.6 million fewer Americans had ACA plans in February compared to the previous year.
The report, first covered by The Associated Press, highlights the impact of subsidy expiration. Cynthia Cox, a vice president at the healthcare research nonprofit KFF, noted the data accounts for those who were retroactively removed due to nonpayment. She stated that the data aligns with expectations, showing a notable decrease in ACA coverage.
Impact of Subsidy Expiration
Healthcare affordability is a major issue for voters. Analysts have monitored ACA enrollment closely, especially after premium tax credits expired, causing insurance fees to rise significantly. These subsidies were central to a contentious debate in Congress. Rising health insurance costs concern voters with upcoming elections.
A recent report by the U.S. Department of Health and Human Services pointed to a federal crackdown on fraudulent enrollments as a reason for the decline. However, analysts attribute it more to subsidy expiration and tighter restrictions on which immigrants can access subsidized plans.
Significant Declines in Key States
Analysis shows Ohio and Oklahoma experienced over 32% declines in ACA enrollment over the past year. Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri also saw significant decreases.
Florida, heavily reliant on ACA due to not expanding Medicaid, saw the largest number of enrollees leave. The state still hosts nearly 4 million enrollees but faced a reduction of approximately 443,000. It remains unclear if those who dropped coverage found alternatives.
Cynthia Cox mentioned that most are likely uninsured, as the ACA marketplace often serves as a last resort. States with the largest declines were those that gained many enrollees during the COVID-19 pandemic when subsidies made coverage more affordable.
New Mexico’s Unique Approach
New Mexico is the only state to see an increase in ACA enrollment, rising by 14%. This was due to the state using its funds to replace lost federal subsidies. Its approach highlights the efforts in some states to mitigate costs for residents, using state-based solutions.
Federal Vs. State Marketplaces
States using the federal marketplace, Healthcare.gov, saw greater enrollment losses compared to those with state-based exchanges. Some state marketplaces took measures to reduce expenses for their residents after the subsidies expired.
New Mexico’s legislative actions represent a notable example. In a special session, lawmakers allocated state funds to cover the subsidy gap, extending this support through mid-2026, with further measures extending it to mid-2027.
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