ACA exchange enrollment has dropped by 13% in West Virginia since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Interestingly, while plan signups during the 2026 Open Enrollment Period were down nearly 17% vs. OEP 2025, effectuated enrollment as of February was actually only down 13%...it was down nearly 20% year over year in January, but actually increased slightly between January and February, which I believe makes West Virginia one of the only states to see that happen this year. Huh.
We'll have to see what develops over the rest of the year, of course, but this is especially unusual given that West Virginia has by far the highest unsubsidized premiums in the country this year (and will next year as well, as you'll see if you read further).
ACA exchange enrollment has dropped by a whopping 25% in Missouri since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down over 12% vs. OEP 2025...but effectuated enrollment in was 18% year over year as of January and 25% lower in February. That's over 86,000 Missourians who have lost their individual market healthcare coverage.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by more than 26% in Mississippi since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 7.3% vs. OEP 2025...but effectuated enrollment was 16.9% lower year over year in January and 26.4% lower as of February.
That's over 68,000 Mississippians who already lost coverage in just the first two months of the year...a number which has almost certainly continued to get worse since then.
ACA exchange enrollment has dropped by 20% in Kansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were only down 3.6% vs. OEP 2025...but effectuated enrollment was 9.3% lower year over year in January, rising to 20% lower as of February.
That's over 36,000 Kansans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by 10% in Arkansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were only down 3.8% vs. OEP 2025...but effectuated enrollment was down over 8% year over year in January and by 10% (around 14,000 enrollees) as of February.
Before I begin, it's important to note that ACA exchange enrollment has dropped in California since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...although thanks to the state providing its own supplemental financial subsidies to partially cancel out the lost federal subsidies, it's not nearly as dramatic a drop-off as in most other states.
Effectuated enrollment was down 9.5% year over year as of March, and has almost certainly continued to drop further since then based on the trend line (see below). That's at least 187,000 fewer Californians enrolled in ACA healthcare coverage this year.
ACA exchange enrollment has dropped significantly in Alaska since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 9.2% vs. OEP 2025...but effectuated enrollment as of January 2026 was down over 12% year over year...increasing to a 13% drop as of February.
The good news, such as it is, is that due to Alaska having such a small ACA population to begin with, this only amounts to around 3,400 people losing coverage...which is small comfort if you're one of those 3,400 people, of course:
Before I begin, it's important to note that ACA exchange enrollment has dropped significantly in Kentucky since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were down 8.6% vs. OEP 2025...but effectuated enrollment was down nealry 11% in January and over 14% as of February; on average nearly 11,000 Kentuckians lost ACA healthcare coverage in the first two months of 2026:
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
Medicare Advantage (technically "Medicare Part C" & originally called "Medicare+Choice") is a type of health plan in the United States offered by private companies as part of the original Social Security Act of 1965 that created Medicare. It permits a private insurance option that wraps around traditional Medicare. Medicare Advantage plans attempt to fill some coverage gaps and offer alternative coverage options.
Under Part C, Medicare pays a plan operator a fixed payment for each enrollee. The operator then pays for their medical expenses. Traditional Medicare directly compensates providers on a fee-for-service basis. Plans are offered by integrated health delivery systems, labor unions, non profit charities, and health insurance companies, which may limit enrollment to specific groups of people (such as union members).
ACA exchange enrollment has dropped by nearly 30% in Arizona since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 15.6% vs. OEP 2025...and effectuated enrollment was 23% lower year over year in January, rising to nearly 30% by February.
That's over 107,000 Arizonans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
