Obamacare rolls shrank dramatically in many states over the past year, new federal data shows

Healthcare affordability is a central issue to voters

Health analysts have kept a close eye on changes in ACA enrollment since the expiration of so-called enhanced premium tax credits caused many Americans’ monthly health insurance fees to double or triple, forcing some to forgo coverage entirely. The subsidies had been at the center of a bitter fight in Congress last fall, with Democrats and some Republicans calling for their renewal.

Health insurance costs have been rising across ACA and other health insurance programs at a time when voters in the approaching November elections say affordability is among their top concerns.

In a report released last week, the U.S. Department of Health and Human Services suggested the significant drop in enrollment this year could be attributed to a federal crackdown on fraudulent or “phantom” enrollment. But analysts have said it was more likely related to the Jan. 1 expiration of federal subsidies, and other changes, including tightened requirements on which immigrants could access subsidized plans.

Ohio, Oklahoma and Arizona saw the most significant drop-offs

An AP analysis of the data finds that Ohio and Oklahoma each saw a more than 32% decline in ACA enrollment over the past year. They lost larger shares of their covered populations than any other state.

Following closely behind, and losing more than a fourth of their enrollees, were Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri.

Florida, a state that relies highly on ACA insurance in part because it did not expand Medicaid and is home to many gig workers and entrepreneurs, still has more residents in the marketplace than any other state, at nearly 4 million. But it also saw the highest number of enrollees drop coverage this year — around 443,000.

The data doesn’t show whether people who dropped ACA health insurance this year found coverage elsewhere, and chances are some of them became insured through employer plans or other options. But Cox said most people who left the marketplace are likely going without insurance, because it is typically a “place of last resort” to get health coverage for people who aren’t eligible elsewhere.

Some of the states that saw the largest enrollment declines were the same ones that saw the biggest enrollment gains after the federal government introduced enhanced subsidies during the COVID-19 pandemic. Cox said that isn’t surprising, because those states likely had large numbers of people who enrolled only because the enhanced subsidies made coverage much more affordable.

Only one state saw an increase in its covered population. New Mexico gained some 14% more enrollees in the government health insurance program compared with the same time last year. It was the only state in the nation that fully replaced the lost federal subsidies using its own funds.

Federal marketplace states saw biggest enrollment losses

About three in five states use the federal marketplace Healthcare.gov, while the rest operate their own state-based marketplaces for ACA insurance.

The new data shows that federal marketplace states overall lost larger shares of enrollees than states with state-based exchanges.

One reason for that could be that many states with their own marketplaces took steps to offset costs for their residents when the enhanced subsidies expired in January.

New Mexico, which saw double-digit enrollment gains, is the most extreme example of that. In a special legislative session last fall, lawmakers in the state approved a plan to use state funds to make up for the missing subsidies through mid-2026. In March, the state’s governor signed a bill to continue making up the difference through mid-2027.

Ali Swenson, The Associated Press

by The Canadian Press

Obamacare rolls shrank dramatically in many states over the past year, new federal data shows

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