Recent state enrollment figures have unveiled a troubling trend regarding Affordable Care Act (ACA) coverage, highlighting a more severe decline than previously expected. The root of the issue seems to lie in Congress’s decision not to extend the enhanced subsidies that had been supporting many enrollees.
An analysis conducted by Georgetown University reveals that states such as Arkansas, Colorado, Maryland, Massachusetts, New Mexico, and New York have experienced a notable number of individuals either canceling their insurance plans or failing to pay their premiums after initially enrolling for coverage in 2026. This data, collected up until April, paints a concerning picture of the current healthcare landscape.
Until now, federal officials have only provided data on the initial sign-ups recorded during the open enrollment period, including those whose coverage was automatically renewed at the end of 2025. However, this does not offer a complete view of the situation.
The 2026 open enrollment period witnessed a decline in sign-ups, dropping by 1.2 million—a 5 percent decrease from the previous year and the most significant reduction since the ACA marketplaces were established in 2014. This downturn suggests deeper issues within the system.
Researchers Stacey Pogue and Sabrina Corlette emphasize the importance of examining actions taken by individuals after receiving their first premium bill. The full impact of the enrollment decline becomes apparent only when considering these subsequent decisions, revealing a more nuanced understanding of the challenges facing ACA coverage today.
Analysts anticipate overall 2026 marketplace enrollment dropping by about 5 million people this year, with more losses to come in 2027 as policies from the One Big Beautiful Bill Act and potential Trump administration regulation changes take effect.
The loss of the enhanced premium subsidies has hit enrollees hard, and health costs will likely play a key role in November’s midterm elections.
Initial data from several state exchanges showed that plan cancellations are up 24 percent compared to March 2025. In states that reported demographics, the people who cancelled were most likely to be middle-income consumers who lost financial help when the enhanced premium tax credits expired.
The lowest-income enrollees were already shielded from rate hikes by state-funded subsidies and were the only group less likely to drop coverage compared to last year.
Maryland, for instance, saw a 13 percent drop between January and April, compared with 3 percent last year. Arkansas saw a 16 percent decrease, double the amount from 2025.
Massachusetts experienced a 14 percent decline, compared with 6.7 percent last year, while New Mexico experienced a more than 8 percent decrease, compared with just 0.5 percent in 2025.
“While a drop-off in this period is not unexpected, the magnitude of the decrease compared to last year is stark,” Pogue and Corlette wrote. “This is a small sample of states, but these early indicators may not bode well for national outcomes.”