Enrollment in state-based ACA marketplaces has fallen 8.5% since last year, according to an Aug. 31 report from the State Marketplace Network that analyzed data from 18 states.
Seven notes:
1. At the start of 2026, the 18 state-based marketplaces saw a 1.4% year-over-year enrollment decline, which has since widened to 8.5%. Consumers who were automatically renewed into plans but did not pay their premiums by April 1 were retroactively dropped from coverage, driving much of the additional loss.
2. The number of people losing coverage through the year is running 33.6% higher than it was at the same point in 2025. Meanwhile, fewer people are signing up for coverage mid-year through qualifying life events like job losses or household changes, with those entries down 18.4%.
3. D.C., New Mexico and Vermont were the only states to show enrollment growth. New Mexico, the only state to enact its own subsidy program to replace the expired federal enhanced premium tax credits, started the year 15.4% above 2025 levels but has since seen that margin narrow to 5.2%. D.C. and Vermont have each lost roughly a quarter of the gains they posted earlier in the year.
4. Adults ages 18 to 26 are leaving marketplace coverage at the highest rates, shrinking by anywhere from 7% to 25.6%, depending on the state. In absolute numbers, adults over 55 represented a slightly larger share of overall losses, accounting for more than 16% of the total enrollment decline.
5. Most reporting marketplaces flagged outsized declines among households earning below 100% of the federal poverty level and those above 400% FPL. The lower-income losses are partly tied to an H.R. 1 provision that cut off premium tax credit eligibility for certain immigrant households below the poverty line. At the upper end, the expiration of enhanced subsidies means households above 400% FPL now pay full price for coverage.
6. Fourteen of the 18 marketplaces recorded double-digit average premium increases for 2026.
7. The share of enrollees who downgraded to a cheaper plan more than doubled compared to 2025, reaching about 7% of all state-based marketplace consumers.
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