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Obamacare enrollment fell sharply across the United States over the past year, with new federal data showing that states such as Ohio and Oklahoma lost nearly one-third of their Affordable Care Act (ACA) enrollees. The drop follows the expiration of enhanced federal subsidies in January, leading to about 2.6 million fewer Americans having ACA coverage in February compared to the same time last year, according to data released in late June by the Trump administration.
The federal data, reviewed by health policy analysts, provides the first comprehensive state-by-state breakdown of these declines. Cynthia Cox, vice president at KFF and director of its ACA program, called the findings significant, stating, "It's in line with our expectations, but it does show a very steep drop in the number of people with ACA coverage." She explained that the numbers include only those who paid their first premiums, capturing people who lost coverage after failing to pay within the grace period. Health insurance costs rose across ACA and other programs just as affordability became a major issue for voters ahead of November's elections.
The expiration of enhanced premium tax credits, which previously helped limit monthly insurance payments and expanded eligibility, led to premium costs doubling or tripling for many. Health analysts say this forced some Americans to forgo insurance altogether. While the U.S. Department of Health and Human Services suggested in a recent report that some of the enrollment drop could be due to efforts to reduce fraudulent sign-ups, most experts point to higher costs and stricter eligibility as primary reasons for the decline. WPBF notes that the largest drops were in Ohio and Oklahoma, which each saw a decline of more than 32%. Other states losing more than a quarter of their enrollees included Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri.
The data also reveals that Florida, which did not expand Medicaid, saw the largest number of residents drop ACA coverage—about 443,000—though it still has nearly four million people enrolled, more than any other state.
Notably, only one state saw an increase in ACA enrollment: New Mexico, which gained about 14% more enrollees after lawmakers used state funds to replace lost federal subsidies through mid-2027. States with their own health insurance marketplaces, such as New Mexico, generally saw smaller declines or even increases in enrollment because they took steps to offset rising costs for residents.
Premiums and deductibles also rose significantly in 2026. KFF reports that the average deductible increased by over $1,000 per person—a 37% jump from the previous year—while the share of people choosing high-deductible, lower-premium bronze plans reached a record high. The expiration of enhanced tax credits especially impacted those with incomes above 400% of the federal poverty level, who were no longer eligible for subsidies and left the market in large numbers.
While some individuals who dropped ACA coverage may have found insurance elsewhere, such as through an employer, Cox said most likely became uninsured since the ACA marketplace is often a "place of last resort" for people who can't get coverage otherwise.
Looking ahead, analysts expect that unless new federal or state subsidies are introduced, ACA enrollment could continue to decline, especially as affordability remains a top concern for many Americans. The full effects of these changes may become clearer as more data becomes available later in the year.