Obamacare rolls shrank dramatically in many states over the past year,
new federal data shows
[July 07, 2026]
By ALI SWENSON
NEW YORK (AP) — States across the country saw steep drops in the number
of people covered by the Affordable Care Act over the past year, with
Ohio and Oklahoma each losing nearly one-third of enrollees, according
to new federal data that provides the first complete 50-state breakdown
of sharp enrollment declines following the January expiration of
enhanced subsidies.
The data, posted in late June by the Trump administration and first
reported on by The Associated Press, reveals how changes in each state’s
insured population led to around 2.6 million fewer Americans having
Obamacare plans in February compared with the same time last year.
It captures not only how many people signed up for or were automatically
reenrolled in plans in 2026, but how many paid their first monthly
premiums to keep coverage, according to Cynthia Cox, a vice president
and director of the ACA program at the healthcare research nonprofit KFF,
who reviewed the dataset. She said it accounts for people who were
retroactively removed from coverage after a nonpayment grace period
ended.
“This is the first time we’ve seen state-level data that shows how much
ACA marketplace enrollment truly fell,” Cox said. “It’s in line with our
expectations, but it does show a very steep drop in the number of people
with ACA coverage.”
Healthcare affordability is a central issue to voters
Health analysts have kept a close eye on changes in ACA enrollment since
the expiration of so-called enhanced premium tax credits caused many
Americans’ monthly health insurance fees to double or triple, forcing
some to forgo coverage entirely. The subsidies had been at the center of
a bitter fight in Congress last fall, with Democrats and some
Republicans calling for their renewal.
Health insurance costs have been rising across ACA and other health
insurance programs at a time when voters in the approaching November
elections say affordability is among their top concerns.
In a report released last week, the U.S. Department of Health and Human
Services suggested the significant drop in enrollment this year could be
attributed to a federal crackdown on fraudulent or “phantom” enrollment.
But analysts have said it was more likely related to the Jan. 1
expiration of federal subsidies, and other changes, including tightened
requirements on which immigrants could access subsidized plans.
Mike Rhoads, deputy commissioner of life and health at the Oklahoma
Insurance Department, cited a crackdown on fraudulent enrollments as one
reason ACA enrollments dropped. But he said in his state, the biggest
factor was money.
“It's all about affordability at this point in time,” he said in an
interview, adding that he expects the problem to continue with insurers
forecast to raise rates again next year.
Ohio, Oklahoma and Arizona saw the most significant drop-offs
An AP analysis of the data finds that Ohio and Oklahoma each saw a more
than 32% decline in ACA enrollment over the past year. They lost larger
shares of their covered populations than any other state.
Following closely behind, and losing more than a fourth of their
enrollees, were Arizona, South Carolina, Minnesota, Indiana, Michigan,
Mississippi, Louisiana and Missouri.
[to top of second column]
|
The healthcare.gov website is seen on Dec. 14, 2021, in Fort
Washington, Md. (AP Photo/Alex Brandon, File)
 Florida, a state that relies highly
on ACA insurance in part because it did not expand Medicaid and is
home to many gig workers and entrepreneurs, still has more residents
in the marketplace than any other state, at nearly 4 million. But it
also saw the highest number of enrollees drop coverage this year —
around 443,000.
The data doesn’t show whether people who dropped
ACA health insurance this year found coverage elsewhere, and chances
are some of them became insured through employer plans or other
options. But Cox said most people who left the marketplace are
likely going without insurance, because it is typically a “place of
last resort” to get health coverage for people who aren’t eligible
elsewhere.
Some of the states that saw the largest enrollment declines were the
same ones that saw the biggest enrollment gains after the federal
government introduced enhanced subsidies during the COVID-19
pandemic. Cox said that isn’t surprising, because those states
likely had large numbers of people who enrolled only because the
enhanced subsidies made coverage much more affordable.
Only one state saw an increase in its covered population. New Mexico
gained some 14% more enrollees in the government health insurance
program compared with the same time last year. It was the only state
in the nation that fully replaced the lost federal subsidies using
its own funds.
Federal marketplace states saw biggest enrollment losses
About three in five states use the federal marketplace
Healthcare.gov, while the rest operate their own state-based
marketplaces for ACA insurance.
The new data shows that federal marketplace states overall lost
larger shares of enrollees than states with state-based exchanges.
One reason for that could be that many states with their own
marketplaces took steps to offset costs for their residents when the
enhanced subsidies expired in January.
New Mexico, which saw double-digit enrollment gains, is the most
extreme example of that. In a special legislative session last fall,
lawmakers in the state approved a plan to use state funds to make up
for the missing subsidies through mid-2026. In March, the state’s
governor signed a bill to continue making up the difference through
mid-2027.
Tim Fowler, public relations coordinator for the New Mexico Health
Care Authority, said the state's rise in enrollment was due to its
healthcare affordability fund that replaced the subsidies.
“In New Mexico, we believe health insurance should protect people
against medical debt, not cause it,” he said.
All contents © copyright 2026 Associated Press. All rights reserved |
