New Federal Data: ACA Marketplace Enrollment Fell to 19.2M — Down ~2.6M Year-Over-Year — After Enhanced Subsidies Expired; Ohio and Oklahoma Each Lost a Third of Enrollees

Federal effectuated-enrollment data posted in late June — analyzed in an ASPE issue brief (June 26) and reported state-by-state by the Associated Press on July 6 — shows about 19.2 million people had ACA Marketplace coverage in February 2026, roughly 2.6 million fewer than in February 2025, following the January 1 expiration of enhanced premium tax credits.

Measured from 2025's 22.1 million peak, KFF puts the decline at 13% and notes average monthly premium payments jumped 58%; KFF projects enrollment could average roughly 17.5 million by the end of 2026. The state picture is stark: Ohio and Oklahoma each lost more than 32% of enrollees; Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana, and Missouri each lost more than a quarter; Florida lost the largest raw number (~443,000).

Only New Mexico gained enrollees (+14%) — the one state that fully replaced the lost federal subsidies with its own funds. HHS separately attributes 2.9 million of the enrollment reduction to program-integrity actions (a distinct measure, not the same 2.6M year-over-year figure).

Every Marketplace dropout is a prospective uninsured sliding-fee patient — a durable uncompensated-care pressure signal for FQHCs nationwide through 2026.