Affordable Care Act Enrollment Drops Sharply Across U.S., With Ohio and Oklahoma Losing Nearly One-Third of Enrollees

Jul 6, 2026

Federal data reveals that Affordable Care Act enrollment fell by 2.6 million people in February 2026 compared to February 2025, following the January expiration of enhanced federal subsidies. Ohio and Oklahoma saw the steepest declines, each losing over 32% of enrollees. Conversely, New Mexico gained 14% after replacing the lost federal funds with state subsidies. The drop highlights growing concerns over healthcare affordability ahead of the November 2026 elections.

ACA enrollment decline nationwide

▪Federal data posted in late June 2026 shows that around 2.6 million fewer Americans had Affordable Care Act plans in February 2026 compared to February 2025.
▪The new federal dataset accounts for individuals who signed up, automatically reenrolled, paid their first monthly premiums, or were retroactively removed after a nonpayment grace period.

Enhanced subsidy expiration impact

▪The expiration of enhanced premium tax credits in January 2026 caused monthly health insurance fees for many Americans to double or triple.
▪The U.S. Department of Health and Human Services attributed the enrollment drop to a federal crackdown on fraudulent enrollment, while analysts point to the January 1, 2026, subsidy expiration.

State-level enrollment variation

▪Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri each lost more than one-fourth of their Affordable Care Act enrollees.
▪Florida experienced the highest absolute loss of coverage, with approximately 443,000 enrollees dropping their plans, though it still maintains the largest marketplace enrollment at nearly 4 million.
▪Ohio and Oklahoma experienced the largest percentage declines in Affordable Care Act enrollment, with both states losing more than 32% of their enrollees over the past year.

Healthcare affordability concerns

▪Health insurance costs are rising across the Affordable Care Act and other programs at a time when voters in the upcoming November 2026 elections cite affordability as a top concern.
▪Mike Rhoads of the Oklahoma Insurance Department stated that affordability is the primary factor driving the enrollment drop, with insurers expected to raise rates again in 2027.

State marketplace mitigation efforts

▪States using the federal Healthcare.gov marketplace generally lost larger shares of enrollees than states operating their own state-based exchanges.
▪New Mexico was the only state to see an enrollment increase, gaining 14% more enrollees after fully replacing the expired federal subsidies with state funds through mid-2027.