The number of people enrolled in Affordable Care Act (ACA) marketplace plans has dropped sharply across the country this year. Overall participation fell from 21.8 million people in 2025 to about 19.2 million in 2026—a decline of nearly 3 million enrollees. The reason points to a single policy change: the expiration of temporary federal subsidies that made coverage affordable for millions.
Those enhanced subsidies were created as a pandemic-era measure under the American Rescue Plan Act in 2021. They were extended through 2025 by the Inflation Reduction Act, but Congress allowed them to expire on December 31st. Unlike the standard ACA subsidies that help people based on income, the enhanced subsidies were available to everyone, making plans dramatically cheaper for households across all income levels.
Only one state has moved to fully replace the federal aid with its own money: New Mexico. That decision has paid off. While enrollment dropped in 49 states, New Mexico saw enrollment grow by 14% this year.
The decline has not been uniform. States with their own insurance marketplaces experienced smaller drops on average—about 6 percent—compared to states relying on the federal HealthCare.gov platform, which saw an average 15 percent decline. Some states have fared worse than others. Ohio and Oklahoma saw the steepest drops, both losing 32% of their enrollees. Arizona lost 30%, South Carolina 29%, and Indiana 28%.
A handful of states with their own exchanges have managed to limit the damage through state-level funding or other policy choices. Connecticut, Illinois, Massachusetts, Pennsylvania, and Texas all saw enrollment decline by less than 5%. The District of Columbia and Idaho also held relatively steady.
Beyond enrollment numbers, another concern emerged: retention. Many people who sign up for ACA plans drop coverage when they cannot afford the first premium payment. Mississippi had the lowest retention rate, with only about 61% of January enrollees keeping coverage through the year. Louisiana, South Carolina, Indiana, and Oklahoma all had retention rates below 70%. States with their own marketplaces performed better. New Mexico, California, Nevada, Vermont, and Idaho all kept at least 95% of their enrollees.
Looking ahead, the cost picture may worsen. Insurers have proposed median premium increases of 14% for 2027—the second consecutive year of double-digit hikes. The uncertainty extends beyond pricing. Some insurers are reassessing their commitment to the ACA marketplace, which could reduce plan choices in affected regions and make coverage harder to find for those who need it.
Source: https://highlandcountypress.com/headlines/obamacare-enrollment-declines-49-states