Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
In any event, most of the material discussed in their story is pretty much everything I've been writing about and warning about for months, and even the enrollment data they acquired is the same as what I have in most cases. They were, however, able to get ahold of hard effectuation numbers for three states which I didn't already know: Arkansas, Nevada and Vermont.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
In any event, most of the material discussed in their story is pretty much everything I've been writing about and warning about for months, and even the enrollment data they acquired is the same as what I have in most cases. They were, however, able to get ahold of hard effectuation numbers for three states which I didn't already know: Arkansas, Nevada and Vermont.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment")...as well as how comprehensive that coverage is, of course.
Yesterday, Pluribus News published a new story about effectuated enrollment across a dozen or so states (the reporters actually consulted with me several times about their data and how to present it, although I somehow didn't end up getting credited in the final version).
So, what does this mean for monthly effectuated enrollment this year? Well, it's pretty safe to say that it's not going to look anything like the ePTC years [ie, 2021 - 2025]; in fact, at least a half-dozen state-based ACA exchanges have posted press releases warning that they're already seeing record levels of plan cancellations.
Instead, it seems pretty clear that the pattern is much more likely to resemble one of the NON-ePTC years. Here's what it would look like if effectuations in 2026 follow the exact path of those years...
...Depending on which year it mimics, average 2026 effectuations will range somewhere between 18.2 million - 20.9 million per month. If so, this would mean anywhere from 1.4 - 4.1 million fewer exchange enrollees than 2025.
Federal Premium Tax Credits have been an important aspect of affordability for marketplace enrollees since the adoption of the Affordable Care Act. Premium tax credits lower the cost of private health plans available through the marketplace and are based on income and household size.
Since 2021, Enhanced Premium Tax Credits (EPTC) totaling $600 million annually in Pennsylvania alone made coverage more affordable than ever for enrollees. As a result, Pennie saw enrollment increase by 50% from 2021 to 2025. Pennie enrollment reached its highest point at half a million total enrollees in 2025. The enhanced tax credits expired at the end of 2025, and Pennie enrollees saw costs double on average to keep their plan in 2026.
New York, like 8 of the other 9 states I've run 2026 effectuated enrollment analysis of so far, once again has unique circumstances which make it an outlier compared to most states when it comes to analyzing ACA exchange enrollment and comprehensiveness of coverage.
This is no coincidence for a simple reason: The only ACA exchanges which provide monthly effectuated enrollment data at all are the 21 which are hosted on a state-based exchange platform...which also tend to be states which offer their own supplemental financial assistance or other special healthcare coverage programs specifically targeted towards the ACA individual market (as an aside, 16 of those 21 states are Democratic-leaning, with the remaining 5 considered either swing states (Georgia, Nevada, Pennsylvania) or red states (Idaho, Kentucky).
The biggest distinction here is that, like DC, Minnesota and Oregon, New York has had a Basic Health Plan (BHP) program in place for the past decade. As my colleague Louise Norris explains:
Just 5 days ago I posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026. Since Maryland Health Connection is one of the few states which publishes effectuated enrollment data on a monthly basis, I was able to look at hard enrollment data (along with demographic breakouts) through March.
As I noted last week, Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
I also noted that as of March, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time, with effectuated enrollment being 12.6% higher than it was a year earlier in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025.
Maryland Health Connection is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly basis, so let's take a look...
Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).
Unlike the other five states I've written updates about so far, however, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time...at least as of March, anyway. Effectuated enrollment was 12.6% higher in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025:
Cost Increases from Washington’s Inaction Drives nearly 70,000 New Jerseyans to Drop Health Coverage since January
Expiration of Federal Subsidies Increase Health Care Costs for Working and Middle-Class New Jerseyans
Residents Urged to Stay Covered to Protect Their Health and Avoid Higher Out-of-Pocket Health Care Costs
TRENTON — -- Inaction by the Trump Administration and Congress to extend federal enhanced premium tax credits for consumers purchasing coverage through health insurance marketplaces under the Affordable Care Act has resulted in nearly 14% of those initially enrolled in health plans through Get Covered New Jersey to drop their coverage. As of April 15, 2026, total enrollment on the State Exchange stood at 440,362 – reflecting a net loss of 68,830 enrollees since the end of Open Enrollment.
The Massachusetts Health Connector is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly (actually weekly) basis, so let's take a look...
Officially, Massachusetts is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.7%).
However, as I expected and have warned about repeatedly, the year over year change in effectuated enrollment is a different story: While effectuated enrollment in January was actually 8.5% higher than January 2025, it has since dropped off rapidly and April 2026 enrollment is actually 4.3% lower than it was a year earlier...that's a swing of 14,000 more plan selections to over 15,000 fewer people actually enrolled.
Overall, average monthly effectuated enrollment is still up slightly for the first four months, but only by around 1,600 people.
