Declines in ACA Coverage Enrollment Due to Subsidy Changes

Recent state enrollment data suggest substantial declines in Affordable Care Act (ACA) coverage, driven by the discontinuation of enhanced subsidies by Congress. Georgetown University analysis shows that monthly enrollment figures through April for states like Arkansas, Colorado, and New York indicate significant numbers of individuals either canceling ACA coverage or failing to pay premiums post-enrollment in 2026.

Currently, federal data only account for initial sign-ups during open enrollment, including those automatically renewed from the end of 2025. The 2026 open enrollment period recorded a 5 percent decline, equating to 1.2 million fewer sign-ups compared to the previous year, marking the steepest drop since the exchanges began in 2014.

Researchers Stacey Pogue and Sabrina Corlette emphasize the importance of examining consumer actions regarding premium payments to understand enrollment trends fully. Projections suggest a total reduction in 2026 marketplace enrollments by 5 million, with further decreases anticipated in 2027 due to legislative changes and potential regulatory adjustments.

The expiration of enhanced premium subsidies has notably impacted middle-income enrollees, leading to increased plan cancellations, with initial reports showing a 24 percent rise in cancellations since March 2025. Meanwhile, state-funded subsidies have shielded the lowest-income enrollees from rate increases, resulting in a lower likelihood of coverage drop-offs compared to the previous year.

Specific states have reported varied declines: Maryland saw a 13 percent reduction from January to April, compared to a 3 percent decrease last year; Arkansas experienced a 16 percent drop, double that of 2025; Massachusetts reported a 14 percent decrease, against a 6.7 percent drop previously; and New Mexico noted an over 8 percent decline versus just 0.5 percent the year before.

Pogue and Corlette highlight the significant decline in these figures, noting that while a reduction is typical, the extent of this year's decrease is concerning and may signal broader national trends.