Millions drop Affordable Care Act plans, new data shows: See states where enrollments dropped most

New federal data shows changes in each state’s insured population led to around 2.6 million fewer Americans having Affordable Care Act (ACA) health insurance plans in February compared with the same time last year. 

Data from the U.S. Department of Health and Human Services suggests a 13% drop in enrollment from 22.1 million people in 2025 to 19.2 million this year could be attributed to a federal crackdown on fraudulent or "phantom" enrollment, but KFF, a health policy research organization, said it was more likely related to the Jan. 1 expiration of the federal subsidies which caused a surge in plan costs that resulted in many people being unable to pay their premiums.

What they're saying:

"We know that real people lost their health insurance coverage," said Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, citing survey findings on people who had left their plans. "This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments."

Ohio, Oklahoma and Arizona saw the most significant Affordable Care Act drop-offs

The Associated Press conducted an analysis of the Centers for Medicare & Medicaid Services Health Insurance Exchange enrollment data and found 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.

Several other states — Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri — lost more than a fourth of their enrollees.

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.

Federal marketplace states saw the 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.

Some families dealing with insurance costs that are doubling, tripling or more

The expired subsidies were first given to Affordable Care Act enrollees in 2021 as a temporary measure to help Americans get through the COVID-19 pandemic. Democrats in power at the time extended them, moving the expiration date to the start of 2026.

With the expanded subsidies, some lower-income enrollees received health care with no premiums, and high earners paid no more than 8.5% of their income. Eligibility for middle-class earners was also expanded.

On average, the more than 20 million subsidized enrollees in the Affordable Care Act program are seeing their premium costs rise by 114% in 2026, according to an analysis by the health care research nonprofit KFF.

Those surging prices come alongside an overall increase in health costs in the U.S., which are further driving up out-of-pocket costs in many plans.

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