New York, like 8 of the other 9 states I've run 2026 effectuated enrollment analysis of so far, once again has unique circumstances which make it an outlier compared to most states when it comes to analyzing ACA exchange enrollment and comprehensiveness of coverage.
This is no coincidence for a simple reason: The only ACA exchanges which provide monthly effectuated enrollment data at all are the 21 which are hosted on a state-based exchange platform...which also tend to be states which offer their own supplemental financial assistance or other special healthcare coverage programs specifically targeted towards the ACA individual market (as an aside, 16 of those 21 states are Democratic-leaning, with the remaining 5 considered either swing states (Georgia, Nevada, Pennsylvania) or red states (Idaho, Kentucky).
The biggest distinction here is that, like DC, Minnesota and Oregon, New York has had a Basic Health Plan (BHP) program in place for the past decade. As my colleague Louise Norris explains:
Just 5 days ago I posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026. Since Maryland Health Connection is one of the few states which publishes effectuated enrollment data on a monthly basis, I was able to look at hard enrollment data (along with demographic breakouts) through March.
As I noted last week, Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
I also noted that as of March, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time, with effectuated enrollment being 12.6% higher than it was a year earlier in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025.
Maryland Health Connection is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly basis, so let's take a look...
Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
Unlike the other five states I've written updates about so far, however, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time...at least as of March, anyway. Effectuated enrollment was 12.6% higher in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025:
Cost Increases from Washington’s Inaction Drives nearly 70,000 New Jerseyans to Drop Health Coverage since January
Expiration of Federal Subsidies Increase Health Care Costs for Working and Middle-Class New Jerseyans
Residents Urged to Stay Covered to Protect Their Health and Avoid Higher Out-of-Pocket Health Care Costs
TRENTON — -- Inaction by the Trump Administration and Congress to extend federal enhanced premium tax credits for consumers purchasing coverage through health insurance marketplaces under the Affordable Care Act has resulted in nearly 14% of those initially enrolled in health plans through Get Covered New Jersey to drop their coverage. As of April 15, 2026, total enrollment on the State Exchange stood at 440,362 – reflecting a net loss of 68,830 enrollees since the end of Open Enrollment.
The Massachusetts Health Connector is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly (actually weekly) basis, so let's take a look...
Officially, Massachusetts is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.7%).
However, as I expected and have warned about repeatedly, the year over year change in effectuated enrollment is a different story: While effectuated enrollment in January was actually 8.5% higher than January 2025, it has since dropped off rapidly and April 2026 enrollment is actually 4.3% lower than it was a year earlier...that's a swing of 14,000 more plan selections to over 15,000 fewer people actually enrolled.
Overall, average monthly effectuated enrollment is still up slightly for the first four months, but only by around 1,600 people.
Covered California, the state's ACA exchange, has published effectuated enrollment data for January & February 2026, so it's time to dig in and see what this might say about national trends.
Officially, Qualified Health Plan (QHP) selections during Open Enrollment were only 2.6% lower than they were in 2025. However, as I expected and have warned about repeatedly, the year over year drop in effectuated enrollment was higher than that in January (down to 1,839,000, a 2.8% drop y/y), and the gap more than tripled in February:
...I'm bringing all of this back up again today because I strongly suspect that the situation is about to reverse itself, with the Trump Administration already preparing to brag about impressive-sounding ACA enrollment numbers for 2026 in spite of the enhanced tax credits expiring less than 60 hours from now...even though the actual negative impact of the expiring tax credits (along with several other administrative policy changes made by CMS this year) likely won't be known for several months after Open Enrollment officially ends in January.
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.
About a month ago, I once again reiterated that the official year over year ACA Open Enrollment Period plan selection drop from OEP 2025 to OEP 2026, which currently stands at around 1.26 million people (23.06M in 2026 vs. 24.32M in 2025) was incredibly misleading for a number of reasons:
Not only are there always some people who never have their enrollment effectuated in the first place due to either the policyholder actively cancelling their policy before it even begins or having it terminated by the carrier due to them not paying their first monthly premium, but that effectuated enrollment can vary widely from month to month due to the "churn" of people either starting or ending exchange coverage.
After calling them out for some sloppy summary numbers which understated the enrollment drop by over 144,000 people out of the gate, I delved into the meat of their false argument:
...the above is fairly minor compared to the most egregiously misleading claim in the WSJ piece, which appears in the next paragraph:
The Congressional Budget Office’s ObamaCare baseline in 2024 assumed 18.9 million people would enroll in plans this year if the enhanced subsidies vanished.
