Affordable Care Act enrollment has seen steep declines across the United States following the expiration of enhanced subsidies, according to new federal data that provides the first complete 50-state breakdown of sharp enrollment shifts. The data, released by the Trump administration and first reported by The Associated Press, reveals that approximately 2.6 million fewer Americans had Obamacare plans in February compared to the same time last year.
Impact of Expired Subsidies
The downturn follows the January expiration of enhanced premium tax credits, which analysts say caused monthly health insurance fees for many Americans to double or triple. This surge in costs has forced some residents to forgo coverage entirely, a trend that has become a central issue for voters nationwide.
Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, noted that the new datasets provide the first clear view of how much marketplace enrollment has truly fallen. According to Cox, the data accounts for both new enrollments and individuals who were retroactively removed from coverage after a nonpayment grace period ended.
"It is in line with our expectations, but it does show a very steep drop in the number of people with ACA coverage," Cox said, as reported by The Associated Press.
Utah Enrollment Trends
The scale of the enrollment shift is evident in state-level metrics. In Utah, the number of people with effectuated marketplace enrollment has seen a notable change. According to 2025 data from KFF, Utah had a total of 372,832 effectuated marketplace enrollments, with 3,578,100 total plan selections recorded during the 2026 Open Enrollment Period according to the Centers for Medicare & Medicaid Services (CMS).
Of those Utah enrollees, 96.2% received Advance Premium Tax Credits (APTCs) and 5.7% received Cost-Sharing Reductions (CSRs), according to KFF. This compares to 2024, when Utah had 372,832 effectuated marketplace enrollments and 96.2% of enrollees received APTCs, according to KFF.
National Enrollment Snapshot
Nationwide, the Marketplace 2026 Open Enrollment Period Report from CMS shows that 23.0 million consumers signed up for 2026 individual market health insurance coverage through the Marketplaces since the start of the period on November 1, 2025. This total includes 15.8 million plan selections through the HealthCare.gov platform and 7.2 million plan selections through state-based Exchanges (SBEs).
CMS reported that 3.4 million consumers were new to the Marketplaces for 2026, while 19.6 million consumers were returning consumers who had active 2025 coverage or were automatically re-enrolled. The HealthCare.gov Open Enrollment period ran through January 15, 2026.
Significant State Declines
The decline has been particularly pronounced in several states. As reported by The Associated Press, Ohio and Oklahoma each lost nearly one-third of their enrollees over the past year.
In Oklahoma, the CMS report shows 261,887 cumulative plan selections for 2026. KFF data from 2025 shows Oklahoma had 298,249 total effectuated marketplace enrollments, with 97% of those receiving APTCs.
In Ohio, the CMS report lists 469,616 cumulative plan selections for 2026. KFF data from 2025 shows Ohio had 560,993 total effectuated marketplace enrollments, with 92% of those receiving APTCs.
Data and Future Outlook
As the 2026 plan year progresses, the healthcare landscape remains heavily influenced by the availability of financial assistance. CMS continues to provide public use files that detail plan selection activity, including demographic information, average monthly premiums, and financial assistance trends.
These files allow for a granular view of how different populations, such as those in rural locations or specific age groups, are interacting with the Marketplace. The data remains a critical tool for understanding the long-term impact of subsidy policies on American healthcare access.
