Marketplace enrollment soared at over 24 million plan selections for 2025, but the enhanced premium tax credits that enabled this surge are set to expire at the end of the year. Some 4.8 million people total will lose their insurance coverage, the Urban Institute estimates in a new report.
This year’s model was designed with 2025 enrollment in mind before simulating the 2026 landscape. The Urban Institute also calculated these differences last year, and the same state came out on top.
Overall, there would be a 21% uninsured change without the subsidies. Here is a state-by-state breakdown — including the District of Columbia — of the potential difference in the uninsured population, from greatest to smallest.
- Mississippi: 65%
- South Carolina: 50%
- Tennessee: 41%
- Texas: 39%
- Georgia: 39%
- West Virginia: 35%
- Alabama: 34%
- Kansas: 32%
- Louisiana: 32%
- Montana: 29%
- Florida: 29%
- Ohio: 26%
- Wyoming: 26%
- South Dakota: 25%
- Arkansas: 24%
- Iowa: 24%
- Arizona: 24%
- Oregon: 24%
- Indiana: 22%
- New Hampshire: 20%
- Oklahoma: 18%
- Nebraska: 17%
- Colorado: 16%
- Michigan: 16%
- Maine: 15%
- Missouri: 15%
- Pennsylvania: 14%
- Delaware: 11%
- Illinois: 10%
- North Dakota: 9%
- Wisconsin: 9%
- Washington: 9%
- Virginia: 9%
- Maryland: 9%
- Idaho: 9%
- New Jersey: 9%
- California: 8%
- Alaska: 8%
- Kentucky: 6%
- Rhode Island: 5%
- Nevada: 5%
- North Carolina: 4%
- New York: 4%
- New Mexico: 4%
- Connecticut: 4%
- Utah: 4%
- Minnesota: 3%
- Massachusetts: 3%
- District of Columbia: 1%
- Hawaii: 1%
- Vermont: Less than 0.5%
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