Charles Gaba's blog

Originally posted 08/10/2026

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:

Originally posted 08/27/2026

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.

I suspect that the main reason it has only dropped by 10% vs. much higher drops in many other states is thanks to their newly-implemented, robust Premium Alignment pricing policy, which I wrote about multiple times last fall.

Originally posted 07/21/2026

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.

Originally posted 08/03/2026

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:

Originally posted 07/30/2026

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:

via Wikipedia:

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).

Originally posted 08/10/2026

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:

via Michigan House Democrats:

Xiong Announces Express Lane Health Enrollment for Eligible Michigan Kids

“Express Lane Enrollment” legislation would enact a streamlined health care enrollment process for eligible children and young adults under 21

LANSING, Mich., April 23, 2026 — State Rep. Mai Xiong (D-Warren) recently introduced legislation that would enact a streamlined enrollment process for children and young adults under 21 who may be eligible for Medicaid and health care programs administered through the Michigan Department of Health and Human Services (MDHHS). Xiong’s House Bill 5884 provides a common sense fix: Express Lane Eligibility (ELE), already authorized under federal law, which allows DHHS to use existing Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) data to streamline Medicaid enrollment for kids and young adults.

Originally posted 10/08/26

Last month I ran a detailed analysis of the most comprehensive, up-to-date effectuated enrollment data for Medicaid, CHIP, Medicare & ACA exchange healthcare coverage changes since January 2025 (when Donald Trump returned to power).

All of the enrollment data was based on official reports via the Centers for Medicare & Medicaid Services (CMS) through May 2026 for Medicare, Medicaid & CHIP and through February 2026 for ACA exchange coverage. I included estimated ACA enrollment data for March, April & May 2026 by extrapolating the limited hard data I did have for about a dozen or so states out nationally, including both a lower- and upper-bound range.

My conclusion at the time was that from January 2025 through May 2026...

via the Michigan House Democratic Caucus (this is actually from back in August):

Xiong, Cherry Introduce Medicaid Buy-In Program to Make Healthcare More Affordable for Michigan Workers

LANSING, Mich., Aug. 26, 2026 — State Rep. Mai Xiong (D-Warren) and state Sen. John Cherry (D-Flint) introduced legislation this week to create a Medicaid buy-in program to make affordable healthcare available for more Michiganders. House Bill 6274 and its companion, Senate Bill 1152, would enable Michiganders earning between 138-200% of the federal poverty level to enroll in the program, giving working class families who don’t typically qualify for Medicaid assistance a more cost-effective alternative to other marketplace plans.

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