Yesterday I noted that the Centers for Medicare & Medicaid Services (CMS) has published a new database which updates the official effectuated ACA exchange enrollment data for all 50 states (+DC) through February 2026.
This means that I finally have comprehensive effectuated enrollment data for the first two months of the year for every state, as opposed to only having Open Enrollment Period (OEP) plan selections, which aren't the same thing.
While there are still four months of effectuated enrollment data missing, this still fills in a lot of the missing pieces of the year over year enrollment puzzle, since this new database also includes state-level effectuations from August - December 2025 as well (previously I only had the national total for those months).
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.
The Illinois Health Benefits Exchange, which operates the states new ACA exchange, Get Covered Illinois, has published their June advisory committee meeting slide deck. Let's dig in!
Enacted state healthcare legislation
HB 0111: DOI Budget Appropriation: Approval of DOI’s budget appropriation request, which includes $72,345,000 in resources to support GCI’s operation and additional headcount to support the hiring of six new GCI positions.
SB 3815: Health Insurance Enrollment Protections: Prohibits insurers from denying enrollment in coverage when an individual has past-due premiums from a previous plan unless specific conditions are met. Prohibiting insurers from stacking past-due premiums on the initial binder payment and requires insurers to offer a 12-month payment plan for past-due premiums.
SB 3508: Annual DOI Administrative Cleanup Bill: Among other insurance-related items, allows GCI to adopt new federal regulations more easily to ensure timely compliance with ACA provisions.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
In any event, most of the material discussed in their story is pretty much everything I've been writing about and warning about for months, and even the enrollment data they acquired is the same as what I have in most cases. They were, however, able to get ahold of hard effectuation numbers for three states which I didn't already know: Arkansas, Nevada and Vermont.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
In any event, most of the material discussed in their story is pretty much everything I've been writing about and warning about for months, and even the enrollment data they acquired is the same as what I have in most cases. They were, however, able to get ahold of hard effectuation numbers for three states which I didn't already know: Arkansas, Nevada and Vermont.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
So, what does this mean for monthly effectuated enrollment this year? Well, it's pretty safe to say that it's not going to look anything like the ePTC years [ie, 2021 - 2025]; in fact, at least a half-dozen state-based ACA exchanges have posted press releases warning that they're already seeing record levels of plan cancellations.
Instead, it seems pretty clear that the pattern is much more likely to resemble one of the NON-ePTC years. Here's what it would look like if effectuations in 2026 follow the exact path of those years...
...Depending on which year it mimics, average 2026 effectuations will range somewhere between 18.2 million - 20.9 million per month. If so, this would mean anywhere from 1.4 - 4.1 million fewer exchange enrollees than 2025.
Federal Premium Tax Credits have been an important aspect of affordability for marketplace enrollees since the adoption of the Affordable Care Act. Premium tax credits lower the cost of private health plans available through the marketplace and are based on income and household size.
Since 2021, Enhanced Premium Tax Credits (EPTC) totaling $600 million annually in Pennsylvania alone made coverage more affordable than ever for enrollees. As a result, Pennie saw enrollment increase by 50% from 2021 to 2025. Pennie enrollment reached its highest point at half a million total enrollees in 2025. The enhanced tax credits expired at the end of 2025, and Pennie enrollees saw costs double on average to keep their plan in 2026.
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.
