Federal Policy
ACA Marketplace Enrollment Drops 15% After Enhanced Premium Tax Credits Expire in 2026
ACA Marketplace enrollment declined nationwide in 2026 for the first time in seven years following the expiration of temporary enhanced premium tax credits, with all states except New Mexico experiencing enrollment losses. Enrollment fell 15% on the federal marketplace (HealthCare.gov), while state-based marketplaces saw smaller declines averaging 6%, particularly in states that partially offset the federal subsidy loss with state funds. The enhanced subsidies, which had driven enrollment growth since their introduction, expired at the end of 2025.
Why it mattersLower marketplace enrollment may increase Medicaid churn and enrollment as subsidy-eligible individuals lose affordable coverage options and potentially qualify for Medicaid instead, affecting state program costs and managed care plan enrollment.