ACA Rolls Shrank Dramatically Last Year07/07 06:17

   

   NEW YORK (AP) -- States across the country saw steep drops in the number of 
people covered by the Affordable Care Act over the past year, with Ohio and 
Oklahoma each losing nearly one-third of enrollees, according to new federal 
data that provides the first complete 50-state breakdown of sharp enrollment 
declines following the January expiration of enhanced subsidies.

   The data, posted in late June by the Trump administration and first reported 
on by The Associated Press, reveals how changes in each state's insured 
population led to around 2.6 million fewer Americans having Obamacare plans in 
February compared with the same time last year.

   It captures not only how many people signed up for or were automatically 
reenrolled in plans in 2026, but how many paid their first monthly premiums to 
keep coverage, according to Cynthia Cox, a vice president and director of the 
ACA program at the healthcare research nonprofit KFF, who reviewed the dataset. 
She said it accounts for people who were retroactively removed from coverage 
after a nonpayment grace period ended.

   "This is the first time we've seen state-level data that shows how much ACA 
marketplace enrollment truly fell," Cox said. "It's in line with our 
expectations, but it does show a very steep drop in the number of people with 
ACA coverage."

   Healthcare affordability is a central issue to voters

   Health analysts have kept a close eye on changes in ACA enrollment since the 
expiration of so-called enhanced premium tax credits caused many Americans' 
monthly health insurance fees to double or triple, forcing some to forgo 
coverage entirely. The subsidies had been at the center of a bitter fight in 
Congress last fall, with Democrats and some Republicans calling for their 
renewal.

   Health insurance costs have been rising across ACA and other health 
insurance programs at a time when voters in the approaching November elections 
say affordability is among their top concerns.

   In a report released last week, the U.S. Department of Health and Human 
Services suggested the significant drop in enrollment this year could be 
attributed to a federal crackdown on fraudulent or "phantom" enrollment. But 
analysts have said it was more likely related to the Jan. 1 expiration of 
federal subsidies, and other changes, including tightened requirements on which 
immigrants could access subsidized plans.

   Mike Rhoads, deputy commissioner of life and health at the Oklahoma 
Insurance Department, cited a crackdown on fraudulent enrollments as one reason 
ACA enrollments dropped. But he said in his state, the biggest factor was money.

   "It's all about affordability at this point in time," he said in an 
interview, adding that he expects the problem to continue with insurers 
forecast to raise rates again next year.

   Ohio, Oklahoma and Arizona saw the most significant drop-offs

   An AP analysis of the data finds that Ohio and Oklahoma each saw a more than 
32% decline in ACA enrollment over the past year. They lost larger shares of 
their covered populations than any other state.

   Following closely behind, and losing more than a fourth of their enrollees, 
were Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, 
Louisiana and Missouri.

   Florida, a state that relies highly on ACA insurance in part because it did 
not expand Medicaid and is home to many gig workers and entrepreneurs, still 
has more residents in the marketplace than any other state, at nearly 4 
million. But it also saw the highest number of enrollees drop coverage this 
year -- around 443,000.

   The data doesn't show whether people who dropped ACA health insurance this 
year found coverage elsewhere, and chances are some of them became insured 
through employer plans or other options. But Cox said most people who left the 
marketplace are likely going without insurance, because it is typically a 
"place of last resort" to get health coverage for people who aren't eligible 
elsewhere.

   Some of the states that saw the largest enrollment declines were the same 
ones that saw the biggest enrollment gains after the federal government 
introduced enhanced subsidies during the COVID-19 pandemic. Cox said that isn't 
surprising, because those states likely had large numbers of people who 
enrolled only because the enhanced subsidies made coverage much more affordable.

   Only one state saw an increase in its covered population. New Mexico gained 
some 14% more enrollees in the government health insurance program compared 
with the same time last year. It was the only state in the nation that fully 
replaced the lost federal subsidies using its own funds.

   Federal marketplace states saw biggest enrollment losses

   About three in five states use the federal marketplace Healthcare.gov, while 
the rest operate their own state-based marketplaces for ACA insurance.

   The new data shows that federal marketplace states overall lost larger 
shares of enrollees than states with state-based exchanges.

   One reason for that could be that many states with their own marketplaces 
took steps to offset costs for their residents when the enhanced subsidies 
expired in January.

   New Mexico, which saw double-digit enrollment gains, is the most extreme 
example of that. In a special legislative session last fall, lawmakers in the 
state approved a plan to use state funds to make up for the missing subsidies 
through mid-2026. In March, the state's governor signed a bill to continue 
making up the difference through mid-2027.

   Tim Fowler, public relations coordinator for the New Mexico Health Care 
Authority, said the state's rise in enrollment was due to its healthcare 
affordability fund that replaced the subsidies.

   "In New Mexico, we believe health insurance should protect people against 
medical debt, not cause it," he said.