February enrollment data shows about 2.6 million fewer Americans kept Affordable Care Act plans than a year earlier, after many who signed up or were auto-reenrolled failed to pay first premiums.
January’s expiration of enhanced federal subsidies likely drove the drop, analysts said, after monthly costs for many consumers doubled or tripled; tighter immigrant eligibility rules also reduced enrollment.
Ohio and Oklahoma each lost more than 32% of enrollees, the steepest declines nationwide, while Florida shed the most people overall—about 443,000—even though it still has nearly 4 million marketplace members.
New Mexico was the only state to post a gain, up about 14%, after replacing the lost federal aid with state funds through mid-2027.
Federal marketplace states generally saw bigger losses than states running their own exchanges, underscoring how state subsidy backstops shaped coverage after the federal aid ended.