Florida Leads Nation in Declining Affordable Care Act Enrollments

Florida’s ACA Enrollment Dip Is a Canary in the Coal Mine for 2026

Florida still wears the crown for the nation’s largest Affordable Care Act Marketplace, but preliminary federal data show it also posted the biggest year over year drop in enrollment for 2026 coverage. More than 260,000 fewer Floridians selected an ACA plan, bringing the state’s total to about 4.5 million plan selections, a decline of roughly 5.5%. (WLRN)

Nationally, the Marketplace is still enormous by historical standards, with about 22.8 million consumers selecting coverage for 2026. But that total is down by roughly 800,000 compared with the same point last year, and most states saw fewer sign ups. (Centers for Medicare & Medicaid Services)

At the center of the story is a familiar industry theme: price sensitivity. The enhanced premium tax credits that expanded affordability during the pandemic era were scheduled to lapse at the end of 2025, and early signals suggest the coverage impact is real, especially in states that rely heavily on subsidized enrollment. (KFF)

“More than a quarter of a million fewer Floridians now get their health coverage through the ACA, the largest net drop in the country.”
WLRN, summarizing CMS data (WLRN)

What the CMS Snapshot Tells Us, and What It Doesn’t

CMS’ Marketplace snapshot is a plan selection count, not effectuated enrollment, and not a final membership tally. But it is the best early read the industry gets on demand, consumer behavior, and where affordability friction is showing up.

Florida’s decline stands out not because the state suddenly became a small ACA market, but because it remains the largest. When a market that size moves, it affects national totals, carrier mix, provider contracting dynamics, and risk pool math in a way that smaller swings elsewhere simply can’t. (WLRN)

One important nuance for insurers and brokers: the enrollment window is closed for most people now. From here, meaningful movement comes primarily through special enrollment periods, changes in income, life events, and operational factors like renewals and payment behavior.

The Affordability Cliff Is the Main Character

For many consumers, the enhanced tax credits translated into low or even zero premium options. The expiration of those credits shifts the consumer conversation from “Which plan is best for me?” to “Can I afford any plan at all?”

KFF estimates that if enhanced premium tax credits are not in effect, average out of pocket premium payments among people receiving tax credits could more than double in 2026, rising from about $888 to about $1,904 annually. (KFF)

That kind of sticker shock tends to create three predictable behaviors:

• Consumers downgrade metal levels or narrow networks

• Healthier members are more likely to exit

• Service and billing volume rises as people shop harder and switch more often

From an underwriting and retention lens, those behaviors matter as much as the headline enrollment number.

Florida’s Market Dynamics Make the Drop Especially Instructive

Florida is a useful case study because it combines very high Marketplace penetration with heavy sensitivity to subsidy design. The state’s large self employed and early retiree populations, along with uneven access to employer sponsored coverage across sectors, means the ACA Marketplace often functions as the default coverage channel rather than a backup option.

So when affordability tightens, Florida doesn’t just lose a few marginal enrollees. It risks losing a meaningful slice of its risk pool, which can create second order impacts: morbidity shift, premium pressure, and more volatility in plan mix.

A Quick Look at the Numbers

Sources: CMS Marketplace 2026 Open Enrollment snapshot; Florida enrollment coverage reporting based on CMS data. (WLRN)

One Bullet Section: What Insurance Leaders Should Watch Next

• Effectuation and non payment: A selection is not a paid member. If premiums rose, first month payment rates could soften.

• Risk pool shift: If healthier consumers exit faster, claims trends can move even if total membership remains large.

• Churn and switching: More shopping activity can raise acquisition and service costs while stressing broker, call center, and enrollment ops.

• State by state outliers: Not every state followed the same pattern, and pockets of growth can reveal what tactics worked. (Axios)

The Policy Backdrop Is Still Moving

Even with open enrollment behind us, the policy conversation hasn’t disappeared. Some lawmakers continue to push for extensions or revival of enhanced credits, though timing and operational complexity are major constraints once rates are set and enrollment is underway. (Politico)

“A delayed deal may cause confusion, result in higher initial costs, and deter enrollment, especially among healthy individuals.”
Politico, describing state and insurer concerns about late changes (Politico)

For insurers, the practical takeaway is that a midyear policy shift, even if it arrives, can create administrative turbulence: systems updates, re determinations, member communications, broker retraining, and potential selection volatility. For agencies and enrollment partners, it can mean a second wave of consumer outreach and a surge of plan change requests.

The Bottom Line for the Insurance Industry

Florida’s drop is not just a Florida story. It’s an early signal of what happens when affordability levers change in a market that’s large, price sensitive, and heavily Marketplace dependent.

The national Marketplace remains huge. But the direction matters, and so does the composition of who stays enrolled. As 2026 unfolds, the winners will be the organizations that treat this moment less like a one time enrollment headline and more like an operating environment shift: tighter affordability, higher churn, and a greater premium on retention, service excellence, and clear consumer guidance.