States With ACA Enrollment Decreases

National ACA enrollment dropped from roughly 24.2 million in 2025 to about 23 million in 2026, showing an overall decline in marketplace participation.

Several states saw significant decreases, with North Carolina losing around 22 percent of enrollees and Ohio down about 19 percent. Only a small number of states reported growth.

In Florida, enrollment fell by approximately 261,000 people, highlighting a large absolute decline even where percentage changes were not reported.

(Shows change from 2025 to 2026 open enrollment periods)

1. North Carolina: –21.1%

2. Ohio: –18.6%

3. West Virginia: –15%

4. Indiana: –14.7%

5. Delaware: –14.7%

6. Oklahoma: –14.4%

7. Oregon: –14.1%

8. Arizona: –13.8%

9. Georgia: –12.8%

10. Missouri: –11.3%

11. Tennessee: –11.3%

12. Wyoming: –8.5%

13. Iowa: –8.4%

14. Alaska: –8.3%

15. Maine: –7.7%

16. Mississippi: –7%

17. Utah: –6.9%

18. South Carolina: –6.6%

19. Kentucky: –6.1%

20. South Dakota: –5.8%

21. Wisconsin: –5.6%

22. New Hampshire: –5.3%

23. Washington: –4.9%

24. Michigan: –4.8%

25. Nebraska: –4%

26. Hawaii: –3.6%

27. Alabama: –3.5%

28. Montana: –3.4%

29. Florida: –3.4%

30. New York: –3.3%

31. North Dakota: –3.2%

32. Arkansas: –2.6%

33. Nevada: –2.5%

34. Kansas: –2.4%

35. Virginia: –2.1%

36. Colorado: –0.9%

37. Illinois: –0.9%

38. Vermont: –0.8%