Colorado: Q1 effectuated enrollment down 5.3% y/y; could drop by up to 9.1% or more by end of 2026

Connect for Health Colorado, the state's ACA exchange, has published effectuated enrollment data for January, February and March 2026, so it's time to dig in and see what this might say about national trends.

Unfortunately, it doesn't provide much demographic data (metal levels, income levels, etc), but it does at least provide the number of effectuated enrollees as well as new and terminated enrollments.

Below is what it looks like compared to the same months in prior years. I'm disregarding the COVID years (2020 - 2023) but am including 2016 - 2019 (none of which included the enhanced federal tax credits) as well as 2024 & 2025.

Officially, Qualified Health Plan (QHP) selections during Open Enrollment were only 1.9% lower than they were in 2025. However, as I expected and have warned about repeatedly, the year over year drop in effectuated enrollment was double that in January (3.8%), and the gap grew in both February and March. For the first quarter of 2026, effectuated enrollment in Colorado is down 5.3% vs Q1 2025.

What might this look like for the rest of the year? Well, here's a visual version of the graph above, with the dotted lines respresenting what the rest of 2026 will look like if the effectuation pattern for the balance of the year follows either last year (2025) or the last pre-COVID year (2019).

If it follows 2025, effectuations will taper off at around 234,000 by December and will average around 240,000 for the year...down 5.9% compared to 2025.

If, on the other hand, it follows the 2019 model, December effectuations will be down to just 220,000 and the average for the year will be around 232,000...down 9.1% y/y.

If you extrapolated either of these out nationally, it would put average effectuated exchange enrollment at anywhere between 1.3 - 2.0 million lower than it was in 2025.

As I've mentioned a few times before, however, it's important to keep in mind that under the ACA, insurance carriers are required to provide a 90-day grace period for enrollees to pay past-due premiums. This means that enrollees whose 2026 policies went into effect on January 1st had until the last day of March to make their first premium payment...which, in turn, means that there will likely be a significant drop in effectuated enrollment which won't actually show up until data for April is published...which likely won't happen until sometime in July for most states...although hopefully Colorado and a few other state-based exchanges will publish it sooner than that.

In addtion, it's also important to keep in mind that Colorado is one of the dozen or so states which have implemented either state-based subsidies or other specific policy measures to help mitigate the damage caused by the enhanced federal tax credits expiring back in December. In Colorado's case, they're providing up to $80 per enrollee per month in state financial help to enrollees who earn up to 400% of the Federal Poverty Level (FPL), which in Colorado's case is over 80% of all enrollees this year.

My guess is that the effectuated enrollment drop will be even higher in states which don't have such policies in place.