Obamacare Enrollment Plunges 13% After Subsidies Expire

New federal data reveals that Affordable Care Act marketplace enrollment has fallen dramatically across the United States, with approximately 2.6 million fewer Americans holding Obamacare plans in February 2026 compared with the same period last year — a 13% decline from 22.1 million to 19.2 million enrollees. The first complete 50-state breakdown, reported by the Associated Press, shows steep drops concentrated in states that relied on the federal Healthcare.gov platform, while only one state — New Mexico — recorded an increase.

Context: The End of Enhanced Subsidies

The enrollment decline follows the January 1 expiration of enhanced premium tax credits, first introduced in 2021 as a temporary COVID-19 pandemic measure and later extended through 2025 by the Inflation Reduction Act. When Congress failed to renew them — after a bitter fight that triggered a 43-day government shutdown — millions of Americans saw their monthly premium payments double or even triple overnight. According to the KFF, returning enrollees faced an average premium payment increase of 114% to keep the same plan, while deductibles rose by over $1,000 per person.

The States Hit Hardest

Ohio and Oklahoma suffered the steepest percentage losses, each shedding more than 32% of their ACA enrollees — the largest declines of any state. Eight other states — Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri — lost more than a quarter of their covered populations. In absolute terms, Florida saw the highest number of people drop coverage, with approximately 443,000 enrollees exiting the marketplace, though it still maintains the largest ACA population at nearly 4 million.

New Mexico was the only state to buck the trend, gaining about 14% more enrollees. The state fully replaced the lost federal subsidies with its own funds through mid-2027, a move officials say reflects a commitment to keeping coverage accessible. Tim Fowler, public relations coordinator for the New Mexico Health Care Authority, told the Associated Press: “In New Mexico, we believe health insurance should protect people against medical debt, not cause it.”

A Clash of Explanations

The reasons behind the enrollment collapse are sharply contested. The Trump administration’s Department of Health and Human Services, in a report released in late June, attributes the decline primarily to a successful crackdown on fraudulent and “phantom” enrollment. The HHS estimates that improper enrollments — where individuals were signed up without their knowledge by brokers seeking commissions — peaked at 5.6 million in 2025 and that 2.9 million such enrollments have since been removed from the system.

Independent health policy analysts offer a different interpretation. Cynthia Cox, vice president and director of the ACA program at KFF, said the data confirms that real people lost coverage precisely when costs became unaffordable. “We know that real people lost their health insurance coverage,” Cox said. “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments.” Mike Rhoads, deputy commissioner of life and health at the Oklahoma Insurance Department, acknowledged that fraud reduction played a role but told the AP: “It’s all about affordability at this point in time.”

Political and Market Implications

The enrollment drop carries significant consequences for the November 2026 midterm elections, where healthcare affordability ranks among voters’ top concerns. A KFF survey found that 73% of returning ACA enrollees worried about affording emergency care, and 44% said higher insurance costs made it harder to afford basic necessities like groceries and rent. KFF projects enrollment could fall further to 17.5 million by the end of the year.

States using the federal Healthcare.gov platform lost larger shares of enrollees than states operating their own exchanges, many of which took steps to offset costs for residents. The disparity highlights how state-level policy choices are shaping access to coverage in the post-subsidy era.

What to Watch For

A House vote on a three-year extension of the enhanced subsidies — forced by four centrist Republicans joining with Democrats — could come in the coming months, though Senate passage remains uncertain. Meanwhile, the Urban Institute has projected that 4.8 million people could ultimately lose coverage due to the subsidy expiration alone. The trajectory of enrollment through the rest of 2026 will offer the clearest signal yet of whether the market can stabilize — or whether the Affordable Care Act is entering a new era of contraction.