Georgia: Effectuated ACA enrollment down 28% y/y; at least 370,000 have already lost coverage

Tue, 04/21/2026 - 3:25pm

More than half a million Georgians have dropped health insurance coverage amid stiff premium price hikes for federally subsidized Affordable Care Act plans, according to data obtained by The Current GA and Georgia Recorder.

The 37% enrollment drop — from 1.5 million Georgians in January 2025 to 950,000 as of April 17, 2026 — dwarfs any previous decline in the state since the launch of so-called Obamacare health insurance plans in 2014.

Repeating what I wrote this morning about the press release out of New Jersey: While the situation is ugly, I have to be intellectually honest: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect, and by that measure it isn't quite as bad as the press release makes it out to be, though lord knows it's bad enough:

Effectuated enrollment as of April is "only" around 370,000 lower than it was in April 2025, or down roughly 28% instead of the 37% stated in the Current GA article, which compares April's effectuated number against the total number of OEP plan selections.

The article doesn't provide the effectuated numbers for January, February or March, so I'm going to assume that they were down by a similar percentage, like so:

Rising prices for health insurance policies bought on Georgia’s health care marketplace occurred after the U.S. Congress and President Donald Trump decided against extending Covid-era “enhanced” health insurance subsidies, which sunset Dec. 31, 2025.

Preliminary data released in January about the number of Georgians enrolled in ACA plans hinted at a sizable decline of 190,000. The more complete numbers have been adjusted after those people who had been reenrolled automatically at the start of 2026 failed to make their first premium payments.

Again, that ~190,000 year over year drop refers to the number of Georgians who selected plans during the Open Enrollment Period.

In any event, here's what effectuated enrollment will look like for the rest of the year in Georgia assuming it follows either the 2025 or 2019 patterns:

If the rest of the year follows the 2025 pattern, effectuations will end December at around 915,000 and will average around 948,000 for the year...down 28% compared to 2025.

If the rest of the year follows the 2019 pattern, effectuations will be at around 887,000 by December, and the average for the year will be around 808,000...down a whopping 33% y/y. That would mean around 430,000 fewer people having ACA healthcare coverage than last year.

Unlike the other states I've covered so far (Colorado, California, Massachusetts & New Jersey), Georgia is the first state in this series which doesn't have any type of program in place to mitigate the damage being caused by the enhanced subsidy expiration: No state-based subsidies, no Premium Alignment pricing, nothing...and it's showing:

Colorado: OEP down 1.9%; March effectuations down 6.1%
California: OEP down 2.6%; February effectuations down 8.5%
Massachusetts: OEP up 3.7%; April effectuations down 4.3%
New Jersey: OEP down 0.8%; April effectuations down 11.6%

Georgia: OEP down 12.3%; April effectuations down 28.0%

You can also see this when you break year over year enrollment out by income bracket: In the other four states, enrollment actually increased in several different brackets thanks to those states implementing mitigation programs, but in Georgia, the only one which saw any increase at all is the 100 - 138% bracket, and I'm guessing most of that is due to enrollees who normally earn slightly less than 100% FPL projecting an actual 2026 household income of just over the 100% threshold (and who are now desperately scrambling to make sure that happens):

In any event, across just these five states so far, here's where things stand in terms of year over year average monthly effectuated enrollment as of the months of the latest data:

Colorado: Down ~13,400
California: Down ~110,000
Massachusetts: Up ~1,600
New Jersey: Down ~57,000
Georgia: Down ~370,000
Total across 5 states: Down ~550,000