ACA Marketplace Enrollment Fell 2.6 Million After Enhanced Subsidies Ended, Though One State Saw Gains

ACA marketplace enrollment fell by approximately 2.6 million people in February compared with the same month last year, federal data posted in late June by the Trump administration shows. The drop occurred after enhanced federal premium subsidies expired on January 1. Every state except New Mexico recorded lower enrollment.

Ohio and Oklahoma each lost more than 32 percent of ACA enrollees over the past year. Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri each lost more than 25 percent. Florida recorded the largest absolute decline, with about 443,000 fewer enrollees, though it retained the highest total enrollment at nearly 4 million.

New Mexico gained 14 percent more enrollees. State lawmakers approved a plan in a special legislative session last fall to use state funds to offset the missing federal subsidies through mid-2026. The governor signed legislation in March extending that offset through mid-2027.

States using the federal Healthcare.gov marketplace experienced larger enrollment losses overall than states operating their own exchanges. The data accounts for individuals retroactively removed from coverage after failing to pay premiums within the allowed grace period, according to Cynthia Cox, vice president and director of the ACA program at KFF. A report released last week by the U.S.

Department of Health and Human Services suggested the enrollment decline could stem from a federal crackdown on fraudulent sign-ups. Analysts have pointed instead to the expiration of the enhanced subsidies, which caused many monthly premiums to double or triple.