ACA exchange enrollment has dropped by more than 11% in Montana since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were only down 5.1% vs. OEP 2025...but effectuated enrollment was 7.6% lower year over year in January, rising to 11.4% lower as of February.

The effectuated enrollment numbers have likely continued to drop more since then (the raw numbers aren't that eyebrow-raising since Montana is a small state, population-wise).

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by more than 26% in Mississippi since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 7.3% vs. OEP 2025...but effectuated enrollment was 16.9% lower year over year in January and  26.4% lower as of February.

That's over 68,000 Mississippians who already lost coverage in just the first two months of the year...a number which has almost certainly continued to get worse since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by 13% in West Virginia since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Interestingly, while plan signups during the 2026 Open Enrollment Period were down nearly 17% vs. OEP 2025, effectuated enrollment as of February was actually only down 13%...it was down nearly 20% year over year in January, but actually increased slightly between January and February, which I believe makes West Virginia one of the only states to see that happen this year. Huh.

We'll have to see what develops over the rest of the year, of course, but this is especially unusual given that West Virginia has by far the highest unsubsidized premiums in the country this year (and will next year as well, as you'll see if you read further).

ACA exchange enrollment has dropped by over 14% in Tennessee since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were down 11.4% vs. OEP 2025...but effectuated enrollment dropped by 14% year over year as of February.

That's over 72,000 Tennesseans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by 10% in South Dakota since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were down 7% vs. OEP 2025...but effectuated enrollment was 10.5% lower as of February.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by NEARLY A THIRD in Oklahoma since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 15% vs. OEP 2025...and effectuated enrollment continued to plummet, down 20% vs. a year prior in January and by over 32% year over year in February.

That's over 85,000 Oklahomans who already lost coverage in just the first two months of the year...a number which has likely continued get worse since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by 7.8% in North Dakota since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of 2025.

Initial signups during Open Enrollment were down 4.4% vs. OEP 2025...but effectuated enrollment was 5.7% lower year over year in January and down 7.8% as of February.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by 23% in Nebraska since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were only down 5% vs. OEP 2025...but effectuated enrollment was 22% lower year over year in January and 23% lower as of February (although, interestingly, effectuated enrollment actually increased slightly from January to February both years).

That's nearly 30,000 Nebraskans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.

ACA exchange enrollment has dropped by 20% in Kansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were only down 3.6% vs. OEP 2025...but effectuated enrollment was 9.3% lower year over year in January, rising to 20% lower as of February.

That's over 36,000 Kansans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:

ACA exchange enrollment has dropped by nearly 30% in Arizona since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.

Initial signups during Open Enrollment were already down 15.6% vs. OEP 2025...and effectuated enrollment was 23% lower year over year in January, rising to nearly 30% by February.

That's over 107,000 Arizonans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.

Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison: