ACA exchange enrollment has dropped significantly in Alaska since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 9.2% vs. OEP 2025...but effectuated enrollment as of January 2026 was down over 12% year over year...increasing to a 13% drop as of February.
The good news, such as it is, is that due to Alaska having such a small ACA population to begin with, this only amounts to around 3,400 people losing coverage...which is small comfort if you're one of those 3,400 people, of course:
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Before I begin, it's important to note that ACA exchange enrollment has dropped significantly in Kentucky since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were down 8.6% vs. OEP 2025...but effectuated enrollment was down nealry 11% in January and over 14% as of February; on average nearly 11,000 Kentuckians lost ACA healthcare coverage in the first two months of 2026:
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Before I begin, it's important to note that ACA exchange enrollment has dropped in Hawaii since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year. Fortunately, the raw number of enrollees who have lost coverage is pretty small due to:
a) Hawaii only having around 1.4 million residents to begin with and
b) Hawaii having a much more robust Employer-Sponsored Health Insurance mandate law than the ACA. Under the Hawaii Prepaid Health Care Act of 1974, employers are required to offer coverage to employees working at least 20 hours per week. In contrast, the federal Patient Protection and Affordable Care Act requires employers to offer coverage to employees working at least 30 hours per week.
As a result, Hawaii's individual/nongroup health insurance market is smaller as a percentage of the total population than it is in most other states.
Before I begin, it's important to note that ACA exchange enrollment has plummeted in Louisiana since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during the 2026 Open Enrollment Period were actually up slightly vs. OEP 2025...but actual effectuated enrollment was 2.3% lower as of January...and then fell off a cliff in February, with enrollment dropping a stunning 26% vs. a year earlier. That's over 69,000 Louisianans who were priced out of coverage in just the first two months of the year:
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Initial signups during Open Enrollment were only down about 2% vs. 2025..but effectuated enrollment began to drop immediately and has continued to drop every month since then.
As of June 2026, effectuated enrollment is down 8.4% vs. a year earlier, and is down 7.7% on average for the year so far. That's around 22,000 fewer Coloradans with ACA exchange coverage so far this year:
Before I begin, it's important to note that ACA exchange enrollment has dropped in Pennsylvania since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...although thanks to the state implementing fairly robust Premium Alignment pricing, it's not nearly as dramatic a drop-off as in most other states.
Initial signups during Open Enrollment were actually slightly higher than last year...but effectuated enrollment began to drop starting in February and has continued to drop at an increasing rate every month since then. As of July 2026, effectuated enrollment is down more than 10% vs. a year earlier, and it's down nearly 4% on average for the year so far. That's 48,000 fewer Pennsylvanians with ACA exchange coverage as of July:
Before I begin, it's important to note that ACA exchange enrollment has dropped in California since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...although thanks to the state providing its own supplemental financial subsidies to partially cancel out the lost federal subsidies, it's not nearly as dramatic a drop-off as in most other states.
Effectuated enrollment was down 9.5% year over year as of March, and has almost certainly continued to drop further since then based on the trend line (see below). That's at least 187,000 fewer Californians enrolled in ACA healthcare coverage this year.
Before I begin, it's important to note that as in most states, ACA exchange enrollment has plummeted in Michigan since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year: Effectuated enrollment was down 27% year over year as of February, and has almost certainly continued to drop further since then. That's at least 131,000 fewer Michiganders enrolled in ACA healthcare coverage this year.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
