Florida lost 450,000 ACA enrollees in 2026 as premiums rose an average of 37% nationally, new data shows

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Robert Applebaum, Miami University

(THE CONVERSATION) At 40%, Florida has the smallest proportion of its workforce receiving health insurance through their employer in the nation.

The state also has one of the highest rates of individuals under age 65 who are uninsured and the highest number and proportion of users of health insurance subsidies under the Affordable Care Act, also known as the ACA or Obamacare.

In December 2025, Congress let ACA subsidy increases that were put in place during the COVID-19 pandemic lapse. At that time, policy analysts and scholars predicted dire consequences for Florida.

The decision not to extend these increased government subsidies of health insurance premiums came after heated partisan debate in Congress and the longest federal government shutdown in U.S. history.

As a gerontologist interested in healthcare policy, I've been looking at the ACA enrollment data during the period since the subsidy changes went into effect to see how Florida residents were affected and how the state compares to the nation overall.

In July 2026, the health policy research group KFF reported the most recent available ACA enrollment data on people who both enrolled and paid their first insurance premium – a process known as effectuated enrollment. This data looks at the period from January 2026 through the end of February 2026.

Who buys their health insurance through the ACA

While the majority of American workers between the ages of 19 and 64 receive health insurance through their employers, many people, especially those who are self-employed or working for smaller businesses, do not.

Florida had and continues to have the most individuals insured through the ACA in the nation, with more than 20% of Floridians under age 65 using the ACA, compared to 7% for the nation overall.

The subsidy change controversy

Under the original ACA legislation that President Barack Obama signed into law in 2010, everyone whose premium was subsidized by the federal government was required to contribute to their insurance plan premium.

People earning 115% of the poverty level – $18,000 in 2010 – contributed 2.1% of the plan's cost, and those earning 400% of the poverty level, which was $60,240 in 2010, contributed 10%. Individuals earning above that amount were not eligible for the subsidy.

In 2021, in hopes of alleviating economic pressures during the pandemic, Congress passed legislation eliminating premiums for people with the lowest incomes and reduced the cost for people with higher incomes. The 10% of ACA enrollees making more than 400% of the poverty level, or $128,000 in 2021, were eligible for a subsidy for the first time.

In the period following these subsidy changes, the number of effectuated enrollees increased from 13.5 million in 2022 to 21.8 million in 2025. In other words, the increased subsidies made the ACA much more attractive to healthcare consumers, as intended.

A June 2026 report from the U.S. Department of Health and Human Services stated that almost 3 million people who received a subsidy in 2025 lost coverage in 2026. The report suggested these subsidies were not appropriate, because many recipients of subsidies were high-income individuals. It claimed others were eligible for other public insurance programs, such as Medicaid.

Moreover, Trump administration officials have contended these improper enrollments were the result of widespread fraud. Many healthcare policy analysts disagree with these contentions about fraud, noting partisan politics have now become part of the dissemination of government reports.

Outcomes so far

The rollback in the subsidy amounts increased premiums for people buying insurance through the ACA by an average of 37%, or $1,000, per year nationally.

As expected, the increase in out-of-pocket costs meant fewer people bought insurance through the ACA. In 2026, 19.1 million Americans had an effectuated health insurance enrollment through the ACA.

This 12.4% drop from 2025 was not distributed evenly across all 50 states. Ohio and Oklahoma tied for the largest drop, with a 32% decrease in ACA enrollments.

Of the seven states with the highest ACA proportional enrollments, three had among the highest rates of people dropping ACA coverage in the nation, with South Carolina losing 29%, Mississippi 26% and Alabama 23%. Utah saw a decrease of 16%.

Florida's effectuated enrollment in the ACA fell 10%, from 4.3 million to 3.85 million. Though the proportional decline was less than in other states, this was the largest number of people in any state who dropped coverage. Texas recorded a 4% decline and Georgia 8%.

ACA enrollment rose in only one state, New Mexico, where it increased 14%. Enrollment was unchanged in Illinois. States that had enacted policy changes to financially support ACA premiums, such as funding their own subsidies, saw smaller declines in enrollment.

For Florida, it is not clear what the decline of 450,000 enrollees in ACA plans will mean for the overall state uninsured rate. Some may transfer to a spouse's policy, while others may find a lower-cost catastrophic insurance policy. The complete picture won't emerge until 2027, when the state uninsured rates are released.

The 2025-26 enrollment changes showed that 2.7 million Americans left the ACA exchange, and 1 in 10 of them reported becoming uninsured.

Prior to the subsidy rollbacks, healthcare policy analysts predicted that about 6 million people would leave the ACA exchange, with an estimated 80% of them – 4.8 million people – becoming uninsured. So far, the outcome has not been as bad as they feared.

Still enrolled, but with lower coverage

The reason for this may be that consumers opted for less coverage rather than dropping it altogether. The 2026 data shows a large drop in the proportion of individuals purchasing the middle-level silver plans – from 56.2% to 42.6%.

At the same time, there was a substantial increase, 29.9% to 39.6%, in people enrolling in the lower cost – and lower coverage – bronze plans. There was also a curious result in that there was a modest increase, from 13.2% to 17.2%, in enrollment in the higher-level gold plans.

What's next

It bodes well that fewer people than expected dropped their ACA insurance coverage. But as the cost of housing, fuel and groceries continues to go up, rising insurance premiums may force more people to drop even catastrophic coverage.

This creates a ripple effect: When patients can't afford health insurance, the cost of caring for them puts more financial pressure on hospitals and medical practices. This can lead to reduced services and closures, which makes healthcare more difficult to access for everyone, not just those on the ACA marketplace.

This article is republished from The Conversation under a Creative Commons license. Read the original article here: https://theconversation.com/florida-lost-450-000-aca-enrollees-in-2026-as-premiums-rose-an-average-of-37-nationally-new-data-shows-287135.