The Affordable Care Act (ACA) marketplace experienced a significant enrollment decline in 2026. While initial enrollment figures already showed weakness, new state-level data reveals an even sharper drop after open enrollment ended. As consumers faced higher premiums and payment deadlines, many chose to leave the marketplace or failed to activate their coverage.
According to recent analyses by the Commonwealth Fund and marketplace data, ACA enrollment fell by 5% year over year during the 2026 open enrollment period. This marks the largest decline since ACA marketplaces launched in 2014. Moreover, enrollment losses continued after sign-ups closed, highlighting growing affordability challenges for many Americans.
Why ACA Enrollment Is Falling
Several factors contributed to the decline in ACA enrollment. First, many consumers faced higher out-of-pocket costs after enhanced federal subsidies expired. As a result, monthly premiums increased, making coverage less affordable for middle-income households. Additionally, some enrollees selected plans during open enrollment but never paid their first premium, causing further membership losses.
Furthermore, insurers continue to reassess their participation in ACA markets. Some carriers have already announced marketplace exits, creating uncertainty for consumers and reducing plan choices in certain regions.
State-by-State Enrollment Losses
Arkansas Experienced the Largest Decline
Among the states analyzed by the Commonwealth Fund, Arkansas recorded the steepest enrollment drop. The state lost 16.2% of its marketplace members between the end of open enrollment and April 2026. This decline illustrates how affordability concerns can quickly affect coverage retention.
Other States Also Reported Significant Drops
The study reviewed enrollment trends in:
- Arkansas
- Colorado
- Maryland
- Massachusetts
- New Mexico
- New York
Each state reported lower enrollment after open enrollment closed. Although New Mexico and New York previously experienced modest post-enrollment growth, both states posted declines in 2026. However, their losses were less severe than those seen elsewhere.
Marketplace Retention Continues to Weaken
Researchers found that many consumers selected coverage initially but later dropped out. In many cases, higher premiums and first-payment requirements contributed to these losses. Consequently, actual enrollment numbers fell below open enrollment totals.
Changes in Health Plan Selection
Bronze Plans Gain Popularity
As healthcare costs increased, more consumers shifted toward lower-premium plans. Bronze plan enrollment represented 39.6% of marketplace selections in 2026, compared with 29.9% in 2025. This substantial increase suggests that consumers are prioritizing affordability over richer benefits.
Silver Plans Lose Ground
Silver plans experienced the most noticeable decline. Their share of total enrollment dropped from 56.2% in 2025 to 42.6% in 2026. While some consumers moved to bronze options, others left the marketplace entirely.
Gold, Platinum, and Catastrophic Plans
Gold plans saw a modest increase in enrollment share. Meanwhile, platinum and catastrophic plans remained relatively stable. Together, these categories accounted for less than 1% of total ACA enrollment in both years.
Impact on Consumers and Insurers
The enrollment decline affects both consumers and insurers. For consumers, higher premiums and deductibles can limit access to affordable healthcare coverage. Many households now face difficult decisions regarding insurance affordability.
For insurers, declining enrollment may lead to a smaller and potentially higher-risk member pool. Consequently, some companies are choosing to leave ACA marketplaces altogether. Several insurers have already announced exits from certain states or from the ACA business entirely.
What These Trends Mean for 2027
Looking ahead, analysts expect ACA enrollment pressures to continue. Federal estimates suggest that additional enrollment declines could occur in 2027 if affordability challenges persist. Rising premiums, reduced subsidies, and insurer withdrawals may further reshape the marketplace landscape.
However, states with their own exchanges and additional financial assistance programs may be better positioned to retain coverage levels. Therefore, state-level policy decisions could play an increasingly important role in future enrollment outcomes.
Key Takeaways
Five Important Findings
- ACA enrollment declined 5% year over year in 2026.
- Arkansas recorded the largest marketplace membership loss.
- Every analyzed state reported post-enrollment declines.
- Bronze plan enrollment increased significantly.
- Silver plan enrollment experienced a major decline.
Conclusion
ACA marketplace enrollment is facing its biggest challenge in years. Higher costs, changing subsidy structures, and insurer withdrawals are contributing to enrollment losses across multiple states. At the same time, consumers are increasingly selecting lower-cost bronze plans to manage rising healthcare expenses. As policymakers and insurers prepare for 2027, enrollment trends will remain a critical indicator of the marketplace’s long-term stability.
