Obamacare enrollment shrank by 2.6 million people in a year. It fell from 21.8 million in 2025 to 19.2 million in 2026, a 12 percent drop and the first decline in seven years, according to a KFF analysis of federal data. The enhanced premium tax credits that had lowered costs for millions of enrollees expired at the end of 2025.

The figures come from KFF’s state-by-state look at 2026 enrollment, written by Justin Lo, Matt McGough and Cynthia Cox. They compare February “effectuated” enrollment, which counts people who picked a plan and then started coverage by paying their premium, using monthly data from the Centers for Medicare & Medicaid Services. The 2026 total is as of May 5, 2026. The Assistant Secretary for Planning and Evaluation at HHS uses a different baseline, 22.1 million for February 2025, and reports a drop of nearly 3 million; KFF used the CMS figure of 21.8 million.

The people behind those numbers are enrollees who had coverage a year ago and do not now. The data count coverage in force, not whether those who left found other coverage somewhere else. For anyone who dropped marketplace coverage after the subsidy change and is deciding whether to come back, the question is whether coverage is still available and at what price, and the answer for 2027 starts Nov. 1.

The 19.2 million count may not be the floor: KFF says enrollment is expected to drop further, potentially as low as 17.5 million.

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The states that lost the most

The losses were uneven. Ohio and Oklahoma each fell just over 32 percent. Arizona dropped 30 percent, South Carolina 29 percent, Indiana 28 percent, Michigan 27 percent, and Mississippi and Louisiana 26 percent each. KFF says the national effectuation rate, the share of people who signed up and had coverage in force in February, slid from 90 percent in 2025 to 83 percent in 2026. Mississippi had the lowest rate in 2026, at 61 percent.

The one state that grew

New Mexico was the only state with an increase, up 14 percent. KFF’s list shows it as the state that replaced the lapsed federal credits with state money. Weighted by enrollment, states that use HealthCare.gov without state subsidies saw enrollment fall 15 percent, while the state-based marketplaces fell 6 percent.

The credits that expired were first passed in a COVID-19 relief package and later extended by the Inflation Reduction Act, KFF’s Oct. 6 update says. The update adds that insurers are “seeking a median premium increase of about 15% for 2027,” so the next round of prices arrives with the subsidies still gone.

Why people dropped off

KFF’s February brief explained the mechanics. Sign-ups alone do not count as effectuated enrollment; a person has to pay. New enrollees generally owe a first premium within 30 days of their coverage start date, and returning subsidized enrollees get a three-month grace period, so coverage for some did not have to end until March 31, 2026. More than four in ten 2025 enrollees had been automatically renewed rather than actively signing up, and KFF said some of them could stop paying after seeing January bills. It estimated that premium payments would rise 114 percent on average for subsidized enrollees who stayed in the same plan.

That brief also warned the picture was unfinished: effectuated enrollment for the full year 2026, which accounts for grace-period terminations, is expected in July 2027.

What the numbers leave out

Enrollment counts do not show who is now uninsured. KFF notes totals can differ by source and measurement date, and the February comparison captures one month, not the whole year. The 2026 count may fall further, which is why KFF’s projection of as low as 17.5 million matters for anyone judging how deep the change runs.

Coming back to the marketplace for 2027

Coverage for 2027 is bought at HealthCare.gov or through a state marketplace. The federal site’s dates and deadlines page says “starting November 1, you can apply for 2027 coverage” and that coverage beginning Jan. 1 requires a plan choice by Dec. 15. Someone who dropped coverage in 2026 can start a new application when that window opens.

Before applying, it helps to have a realistic estimate of 2027 household income, since income decides whether a premium credit is available at all. The expired enhanced credits are not coming back on their own, so the premium shown at checkout is the number to plan around, and the 2027 prices will not match the 2026 ones.

In states with their own subsidies, such as New Mexico, the state marketplace is the first place to look, because state money may change what the premium is.

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This article was produced with AI assistance and edited for accuracy against the sources linked above.