New 50-state data shows steep drops in Affordable Care Act enrollment

Key Points:

• States nationwide experienced significant declines in Affordable Care Act (ACA) enrollment over the past year, with Ohio and Oklahoma each losing over 32% of enrollees following the expiration of enhanced subsidies in January.
• The reduction in ACA coverage contributed to approximately 2.6 million fewer Americans having Obamacare plans in February 2024 compared to the previous year, driven largely by increased premiums and affordability challenges.
• Analysts suggest the enrollment drop is primarily due to the end of federal premium tax credits rather than a federal crackdown on fraudulent enrollments, with many states tightening eligibility and immigrants facing reduced access to subsidized plans.
• States operating their own ACA marketplaces generally saw smaller enrollment losses or gains, exemplified by New Mexico, which fully replaced lost federal subsidies with state funds and saw a 14% increase in enrollees.
• Florida, despite having the largest ACA marketplace population at nearly 4 million, experienced the highest absolute number of coverage losses (around 443,000), highlighting ongoing affordability issues amid rising health insurance costs nationwide.