Obamacare rolls shrank dramatically in many states over the past year, new federal data shows
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- ACA marketplace enrollment fell by approximately 2.6 million Americans in February compared with the same time the previous year, per data posted in late June by the Trump administration and reviewed by KFF vice president Cynthia Cox.
- Ohio and Oklahoma each posted ACA enrollment declines exceeding 32% year-over-year, the steepest share losses of any state.
- Florida retained the nation's largest ACA marketplace at nearly 4 million enrollees but lost the most in absolute terms — about 443,000 people — during the year.
- New Mexico was the only state to post an enrollment gain, adding roughly 14% more enrollees after becoming the sole state to fully replace expired federal subsidies with its own funds through mid-2027.
- Federal-marketplace states — roughly three in five — lost larger enrollment shares than state-based-exchange states, which analysts tie to many state-based exchanges taking steps to offset the lost subsidies.
- The U.S. Department of Health and Human Services attributed part of the decline to a crackdown on fraudulent or "phantom" enrollment, but Cox and other analysts pointed to the January 1 expiration of enhanced premium tax credits as the more likely driver.
- Cox said the data doesn't track whether dropouts secured other coverage, but noted the ACA marketplace typically serves as a "place of last resort," suggesting most who left are now uninsured.
Why it matters: With voters citing affordability as a top concern ahead of November elections, the roughly 2.6 million-person ACA enrollment drop — concentrated in states like Ohio, Oklahoma, and Florida that posted the largest subsidy-era gains — likely translates into a significant rise in the uninsured population in non-Medicaid-expansion states. New Mexico's offsetting state subsidies, which kept its enrollment growing by about 14%, show that the post-subsidy landscape now hinges on whether state governments can or will replace the lost federal aid.
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