Map: Where Obamacare Enrollment Is Falling

Jul. 15—For the first time since 2019, enrollment in health insurance programs offered through Affordable Care Act health exchanges has declined. According to data released at the end of June, total marketplace enrollment in February 2026 was 19.2 million, down from 22.1 million in February 2025.

It's unknown how many of the 3 million who dropped coverage found insurance elsewhere, but the ACA was specifically created for people not covered by their employers, Medicaid or Medicare who were unable to afford private health insurance.

The decline adds to a growing national problem. In May, the National Center for Health Statistics estimated that 28 million Americans younger than 65 did not have health insurance in 2025, before changes to the ACA and Medicare in the One Big Beautiful Bill Act took effect.

Enrollment in Medicaid, the insurance safety net for low-income Americans, dropped by nearly 5 million between March 2025 and March 2026. This number could double by 2028, according to some estimates.

New Mexico Stands Alone

At the state level, the steepest declines were in Ohio, Oklahoma and Arizona — all 30 percent or more.

New Mexico was the only state where enrollment increased, a consequence of its decision to fund cost sharing for coverage purchased through the state marketplace, BeWell. "We won't stand for it," Gov. Michelle Lujan Grisham said of the premium increases all but assured when federal subsidies ended.

Fraud, or Sticker Shock?

A report from the U.S. Department of Health and Human Services attributes the 2025-2026 drop to a 3 million- person decrease in marketplace enrollment it says was fraudulent or improper. But KFF Senior Vice President Cynthia Cox notes that the decline coincides with double- and triple-digit increases in marketplace plan premiums.

The "benchmark plan" for measuring ACA premiums is the Silver plan, the ACA's second-lowest-cost plan. Until 2026, such a plan would cost between 0 percent and 8.5 percent of household income.

An Urban Institute analysis found the cost of benchmark coverage increased an average of 2 percent annually between 2020 and 2025. The 2026 increase, 21.7 percent, was 10 times greater. The Urban Institute projected that the cost of coverage for individuals or families with income below 250 percent of the federal poverty level could increase fourfold in 2026.

The count is ongoing. The Centers for Medicare and Medicaid Services reports monthly on the number of exchange policies. In May, KFF estimated that total enrollment could fall to 17.5 or even 16.5 million in 2026.

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