ACA Marketplace Enrollment Falls in 49 States

ACA marketplace enrollment fell in 49 of the 50 states plus Washington, D.C. between February 2025 and February 2026, according to CMS data published in late June. The decline reflects a broader shift across the health insurance marketplace, driven largely by the expiration of enhanced federal premium subsidies and a wave of insurer exits from the exchanges.

Which States Saw the Steepest ACA Marketplace Enrollment Declines

Ohio, Oklahoma and Arizona posted the steepest year-over-year declines in ACA marketplace enrollment, each shedding roughly 30% of enrollees. Ohio’s enrollment dropped from 497,443 in February 2025 to 336,058 in February 2026, a 32% decrease. Oklahoma fell from 265,157 to 179,600, also a 32% decrease, while Arizona dropped from 363,110 to 255,927, a 30% decrease.

New Mexico Bucked the National Trend

New Mexico was the only state to post a gain in ACA marketplace enrollment, rising 14% from 69,915 to 80,047. Notably, New Mexico was the only state that fully replaced the expired federal enhanced premium subsidies for 2026 coverage, which likely explains its divergence from the national pattern.

National ACA Marketplace Enrollment Numbers

Total ACA marketplace enrollment stood at nearly 19.2 million in February 2026, down 12% from nearly 21.8 million at the same time the previous year. Effectuated ACA marketplace enrollment — meaning people actually covered after paying their first premium — had peaked at 22.5 million in August 2025, while the all-time record for total enrollment was 24.3 million, set during the open enrollment period for 2025 coverage.

Full State-by-State ACA Marketplace Enrollment Changes

Why ACA Marketplace Enrollment Is Declining Nationally

The national decline in ACA marketplace enrollment has coincided with insurer exits from the exchanges. Nine insurers announced this year alone that they will stop offering ACA marketplace plans nationally or in specific states after the 2026 plan year, citing declining enrollment, rising premiums, a deteriorating risk pool and the expiration of enhanced subsidies.

What This Means Going Forward

With enrollment falling in nearly every state and insurers continuing to exit certain markets, ACA marketplace enrollment trends will likely remain a closely watched indicator of how the subsidy expiration and shifting risk pools reshape the exchange landscape heading into the 2027 plan year.