Approximately 2.6 million fewer Americans had Affordable Care Act (ACA) plans in February 2026 compared with February 2025. The U.S. Department of Health and Human Services released federal data providing a 50-state breakdown of ACA enrollment in late June 2026.

Enhanced premium tax credits for ACA plans expired on January 1, 2026. The U.S. Department of Health and Human Services released a report last week suggesting the drop in enrollment could be attributed to a federal crackdown on fraudulent or "phantom" enrollment.

Cynthia Cox, vice president and director of the ACA program at KFF, commented on the data. "It's in line with our expectations, but it does show a very steep drop in the number of people with ACA coverage," Cox said.

States that utilize the federal marketplace, Healthcare.gov, for ACA insurance generally experienced larger declines in enrollees compared to states with their own state-based exchanges. Approximately three in five states use Healthcare.gov.

Ohio and Oklahoma each saw a more than 32% decline in ACA enrollment over the past year. Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri each reported losing more than 25% of their ACA enrollees during the same period. In Florida, approximately 443,000 enrollees dropped ACA coverage in the past year, though the state still has nearly 4 million residents in the marketplace.

New Mexico gained approximately 14% more ACA enrollees in February 2026 compared with February 2025. New Mexico was the only state to fully replace the expired federal subsidies using its own funds. Lawmakers in New Mexico approved a plan in a special legislative session last fall to use state funds to make up for missing federal subsidies through mid-2026. The governor of New Mexico signed a bill in March 2026 to continue using state funds to cover missing federal subsidies through mid-2027.

The enrollment data takes into account individuals who signed up for or were automatically reenrolled in plans in 2026 and those who paid their first monthly premiums to maintain coverage. It also accounts for people who were retroactively removed from coverage after a nonpayment grace period ended.