Obamacare enrollment falls in 49 US states after subsidies end

Enrollment in Affordable Care Act (Obamacare) plans dropped in 49 states after the enhanced federal subsidies, created by the American Rescue Plan Act and extended by the Inflation Reduction Act, expired on Dec. 31. The Trump administration reported a loss of nearly 3 million participants, bringing total enrollment to about 19.2 million, down from a record 21.8 million in 2025.

Kaiser Family Foundation analysis shows the average decline was 6 % in states that run their own exchanges and 15 % where the federal marketplace is used. The steepest drops occurred in Ohio and Oklahoma (‑32 %), Arizona (‑30 %), South Carolina (‑29 %), Indiana (‑28 %), Michigan and Minnesota (‑27 %), and Louisiana and Mississippi (‑26 %). New Mexico was the sole state with a rise, posting a 14 % increase after using state funds to replace the expired aid. The administration attributed part of the decline to the removal of “improper, phantom and fraudulent” enrollments, while KFF linked it primarily to the subsidy expiration, which had previously eliminated premiums for many low‑income households.