Enrollment in ACA plans hit a record high of 21.4 million in 2024, driven by premium subsidies.
The enhanced ACA subsidies, which offer premium assistance to individuals earning up to 400% of the federal poverty level, are set to expire at the end of 2025 unless Congress extends them. If allowed to lapse, premium costs could rise, potentially causing 3.4 million Americans to lose health coverage.
According to the Urban Institute, allowing premium subsidies to expire would increase uninsured rates by an estimated 16% nationally and reduce subsidized marketplace coverage by 42%.
States ranked by percent change in individuals who will be uninsured if ACA subsidies expire:
Mississippi: 43%
Tennessee: 39%
Alabama: 34%
Georgia: 32%
Louisiana: 32%
South Carolina: 32%
Arkansas: 30%
Ohio: 29%
Texas: 27%
Idaho: 25%
Kansas: 24%
Indiana: 22%
Florida: 21%
Kentucky: 21%
Iowa: 20%
Michigan: 18%
New Hampshire: 18%
West Virginia: 18%
Oklahoma: 17%
Arizona: 16%
Wyoming: 15%
Nebraska: 13%
Missouri: 12%
Montana: 12%
South Dakota: 12%
New Jersey: 11%
North Carolina: 9%
Colorado: 8%
Delaware: 8%
Wisconsin: 8%
California: 7%
Maryland: 7%
Oregon: 7%
Virginia: 7%
Minnesota: 6%
North Dakota: 6%
Rhode Island: 6%
Utah: 6%
Washington: 6%
Connecticut: 5%
Maine: 5%
Pennsylvania: 5%
Illinois: 4%
Alaska: 3%
Massachusetts: 3%
Nevada: 3%
Vermont: 3%
New Mexico: 1%
New York: 1%
Hawaii: 0%