CMS posts March 2026 enrollment report: ~5.2 MILLION fewer Americans have Medicaid/CHIP coverage since Trump returned

Charles Gaba — Thu, 23 Jul 2026 15:30:20 +0000

Thu, 07/23/2026 - 11:30am

The Trump Regime has dropped about 1.5% from February 2026, or over 1.1 million people.

The all-time high enrollment watermark for Medicaid/CHIP was in (referenced above) and the June 2025) while the Trend Snapshot is only 4 months out of date (through March 2026).

The MBES count includes individuals enrolled in limited benefit plans and the Performance Indicator count does not include such individuals.

The MBES data represents the count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period, while the Performance Indicator data captures the count of individuals enrolled on the last day of the month.

The MBES count only includes individuals whose coverage is funded through Medicaid (title XIX of the Social Security Act), while the published Performance Indicator also includes individuals funded through CHIP (title XXI of the SSA).

MBES and Performance Indicator data may be derived from different state systems.

Retroactive state adjustments to MBES or Performance Indicator data may be in progress.

States have likely generated MBES data and Performance Indicator data from state systems on different dates.

The other major difference: The MBES reports include Medicaid enrollees in the U.S. territories: American Samoa, Guam, N. Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

The MBES numbers for U.S. territories stood at 1.44 million Medicaid enrollees as of June 2025. If you add those to the Trend Snapshot total for the 50 states +DC, it comes in at 75.7 million as of March 2026.

It's also worth noting that ACA Medicaid Expansion enrollment specifically was 20.4 million as of June 2025 according to the MBES report, down around 3.6 million from the all-time high it reached in May 2023.

Between December 2024 (the last full month before Trump took office again) and March 2026, net Medicaid/CHIP enrollment has dropped by nearly 5.2 million, or 6.5%.

This ranges from virtually no net enrollment change at all in North Carolina to as much as a 20.5% drop in Medicaid/CHIP enrollment in Indiana, where there are 366,000 fewer Hoosiers enrolled in either program than at the beginning of Trump 2.0.

In terms of raw numbers, the largest decline in enrollment is California, as you'd expect, where over 1.5 MILLION residents have been removed from the Medicaid/CHIP rolls since December 2024 (an 11.3% drop).

Of course, Medicaid/CHIP enrollment dropping isn't necessarily a bad thing if the reason is because those folks instead moved to other types of comprehensive healthcare coverage instead such as individual coverage (ACA marketplace), Medicare or employer-sponsored coverage. However, given what's happening with the ACA marketplace this year and that 200,000 more Americans were unemployed in , that's not terribly comforting.

Medicare enrollment, on the other hand, has gone up by over 1.3 million since January 2025, which does cancel out some of the Medicaid/CHIP losses...except that most of those additional Medicare enrollees didn't shift from Medicaid/CHIP. Most of them aged out from employer coverage, while some turned 65 and transitioned from ACA policies or other types of healthcare coverage.

Wed, 07/22/2026 - 4:18pm
Last September, just ahead of the 2026 ACA Open Enrollment Period, the Colorado legislature passed emergency legislation to generate funding to backfill around 40% of the premium subsidies which were lost when Congressional Republicans refused to extend the enhanced federal tax credits:

DENVER - Colorado Insurance Commissioner Michael Conway released the following statement on Governor Polis signing HB 25B-1006 into law, legislation that provides funding to the individual healthcare market to reduce catastrophic premium increases:

“I’m grateful Colorado lawmakers heeded our call about catastrophic price increases for the individual healthcare market and passed a temporary fix this special session. This stopgap measure will provide crucial funding to reduce the rise in premium costs for working families. But without Congress stepping up to extend enhanced premium tax credits, tens of thousands of hardworking Coloradans will lose their healthcare, and those who remain enrolled can expect to see average net rate increases of more than 100%, and for many, almost 200%.”

More specifically, for 2026 only, the state subsidies provide $80/enrollee per month for the first member of the households and an additional $29/enrollee per month for each additional member of the household, for up to 5 household members total.

As far as I can estimate, this is saving around ~270,000 Colorado ACA enrollees roughly $450 apiece on average this year, although they're still paying an average of $900 more apiece in premiums, mostly as a result of the enhanced federal subsidies expiring.

Since this was emergency legislation, however, it was only put into place for the 2026.

Fortunately, however...

Authorizes the health insurance affordability enterprise (enterprise), on or after January 1, 2027, to issue revenue bonds of up to $100 million to fund enterprise programs, secured by the enterprise's revenues, and require the enterprise to pay bond obligations before allocating revenues for enterprise programs;

Allows the enterprise to invest specified money in the health insurance affordability cash fund (cash fund) without regard to otherwise applicable requirements for such investments and to contract with private professional fund managers to advise on investment strategies;

Modifies the allocation of enterprise revenue among authorized purposes and allows the enterprise to reallocate unexpended amounts for specified purposes;

Directs the enterprise to require qualified individuals who are enrolled in state-subsidized individual health coverage plans eligible for subsidies from the enterprise to pay premiums established in rules adopted by the commissioner, in consultation with the health insurance affordability board (board);

Requires the enterprise to adjust the statewide average premium reduction under the reinsurance program to 18% and to reduce the amount of bonds issued to account for the reduced costs for the reinsurance program;

Directs the board, in recommending parameters for implementing subsidies for state-subsidized individual health coverage plans, to recommend coverage that prioritizes enrollment stability and customer predictability; when seeking input on its recommendations regarding plans, coverage, and the number of eligible slots, to enable feedback in at least English and Spanish and in other languages upon request; and to indicate how it incorporated such feedback into its final recommendations;

Directs the enterprise to conduct or contract a third party to conduct a study to evaluate the feasibility of restructuring the enterprise programs to increase health insurance affordability and maximize enrollment in health insurance plans;

Requires the enterprise to submit 3 written reports and make one in-person presentation to the joint budget committee each year regarding the status of the cash fund and, as part of its in-person presentation in January 2027, to provide an analysis of the effects of changing the statewide average premium reduction under the reinsurance program to 15% and of creating a tiered, income-based, structure for premium assistance for individuals who purchase insurance on the Colorado health benefit exchange (exchange);

Repeals the tax credit for contributions to the exchange and replaces it with a tax credit for contributions to the enterprise; and

Directs the state treasurer to transfer $40 million from the marijuana tax cash fund to the cash fund by June 30, 2026, reduces to $60 million the designation of money in the marijuana tax cash fund as the state emergency reserve for the 2025-26 and 2026-27 state fiscal years, and increases by $40 million the value of the capitol annex building for purposes of the state emergency reserve for the 2025-26 and 2026-27 state fiscal years.
Colorado
C4HCO
2027 Open Enrollment
State Subsidies
- Tue, 07/21/2026 - 2:06pm
  Before I begin, it's important to note that ACA exchange enrollment has dropped in California since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...although thanks to the state providing its own supplemental financial subsidies to partially cancel out the lost federal subsidies, it's not nearly as dramatic a drop-off as in most other states.
  
  Effectuated enrollment was down 9.5% year over year as of March, and has almost certainly continued to drop further since then based on the trend line (see below). That's at least 187,000 fewer Californians enrolled in ACA healthcare coverage this year.
  
  Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
  
  With that in mind, here's federal lawmakers failed to extend enhanced federal tax credits that helped millions of Americans afford their monthly premiums. This year, the Trump administration cut eligibility for lawfully present immigrants, added administrative burdens to families applying for financial help and made it more difficult for gig workers who have to recalculate their income on an annual basis.
  
  “The federal government and this administration have made it more difficult for hard-working Americans to access high-quality health insurance at a price they can actually afford,” said Covered California Executive Director Jessica Altman. “The fallout from these federal actions continues to reduce affordability and put health insurance out of reach for too many — something our state is fortunately counteracting.”
  
  California is continuing to fight for affordability and health care access by adding more insurance options and expanding the state’s subsidy program that will help one in four enrollees reduce their monthly premium.
  
  “Since Republicans have not been able to repeal the Affordable Care Act, this administration has instead tried to do all it can to weaken and spread misinformation about ACA marketplaces like Covered California. Unfortunately for them, it’s not working,” said Governor Gavin Newsom. “California continues to lead the way in providing vital access to affordable health insurance. Our original subsidy program was an inspiration for the enhanced premium tax credits nationally that expired at the end of last year, and our expanded state subsidy program shows a path forward to protect affordability for the most vulnerable Americans.”
  
  Expanded State Subsidy Program Reaching More Californians and Supporting the Most Vulnerable
  
  In 2026, Gov. Newsom and the California Legislature increased the amount of state funds available for the Covered California State Subsidy Program, appropriating $300 million in Health Care Affordability Reserve Fund (HCARF), up from $190 million. As a result, Californians with incomes up to 200 percent of the federal poverty level in 2027 ($31,920 for an individual or $66,000 for a family of four) will be eligible for financial help to lower the cost of monthly premiums.
  
  It's important to note that in 2026, the CA State Subsidy Program fully backfills lost federal subsidies for enrollees earning up to 150% FPL and provides a small subsidy for those earning 150 - 165% FPL. I'm not sure whether the expansion up to 200% FPL fully backfills them or not.
  
  While the state subsidy program is not enough to fill the gap left by the expiration of enhanced federal subsidies, more than 500,000 Californians are projected to receive a state subsidy in 2027, about 30 percent of all enrollees. Additionally, nearly 200,000 can choose from two Silver-tier plans with a $0 premium.
  
  “Investing in the health of our residents is good for people. It’s also good policy,” said Governor Newsom. “The federal government has decided that health care affordability is not a priority, so California is stepping up once again to help families most in need across our state.”
  
  Covered California estimates the state subsidy program will open financial help to an additional 200,000 Californians who weren’t eligible in 2026 and prevent 90,000 people from dropping coverage in 2027.
  
  “When people have access to health insurance, they face less risk of financial hardship due to a medical issue, they miss fewer days of work, and they’re able to contribute more to their families and communities,” said Altman. “We’re grateful for Gov. Newsom and the California Legislature for passing these critical investments to help more Californians get connected to the coverage they need.”
  
  California’s Individual Market Changes for 2027
  
  Despite ongoing federal rule changes that affect eligibility and affordability, Covered California maintains a strong marketplace, with 1,785,000 enrollees as of March 2026, and engages in active negotiations with health insurance companies to help keep Covered California one of the most affordable options for health insurance.
  
  This has helped ensure that California’s rate increase of 9.9 percent is significantly lower than the preliminary national median rate increase of 14 percent. It’s also why for most of the past decade, the average cost for a benchmark plan in California has been lower than the national average.
  
  I should note that my own calculations put the national average preliminary rate increase at around 14.6% across 17 states (including California).
  
  Covered California’s 9.9 percent increase for 2027 reflects an average of proposed rates across all health insurance companies that offer individual plans. As it does every year, actual rates can differ greatly by plan and region. They are subject to final review and public comment by California’s Department of Managed Health Care (see Table 1: Covered California Individual Market Rate Changes by Rating Region and Table 2: California Individual Market Rate Changes by Carrier). Final rates will take effect on Jan. 1, 2027.
  
  Covered California Continues to Provide Affordability, Value
  
  Despite rising premiums and declining enrollment across the country, Covered California has connected 1.785 million Californians to health insurance this year, the second highest mark in its history.
  
  “It really shows the value of having a Covered California plan, that even when prices increase, people are choosing to keep or switch their health plans rather than lose insurance altogether,” said Altman. “It’s clear that once people get access to health insurance, they want to keep it, so it is critical that we continue to fight and find ways to make that access affordable for all Californians.”
  
  Despite a weighted average rate increase of 9.9 percent, most Covered California enrollees will be protected from higher monthly premiums. Thanks to existing federal tax credits and California’s expanded subsidy program, 60 percent of enrollees will see no increase in their monthly premium, 26 percent will remain eligible for $0 premiums without changing plans, and many others may actually pay less each month.
  
  Another way to reduce costs for consumers is to increase competition and options. In 2027, 12 health insurance carriers will offer plans across the state, ensuring that all Californians have access to two or more choices. Additionally, 92 percent will be able to choose from three carriers or more, and nearly 75 percent will have four or more carriers to choose from.
  
  All of this works together to help make health insurance as affordable as possible for families across California:
  
  A couple in Los Angeles earning around $38,000 could get a Bronze plan with a $0 monthly premium.
  
  A family of four in Sacramento with an income around $82,000 could get a Silver plan for less than $580 a month.
  
  A family of three in Orange County earning around $41,000 a year could get a Silver plan for less than $240 a month.
  
  Additionally, one new insurance company, CalOptima Health, is entering the marketplace in 2027 in Region 18 to serve Orange County, while Molina Healthcare will no longer offer marketplace plans in Regions 15 and 18. Molina’s approximately 1,600 enrollees in these regions will be allowed to choose a new plan or move to the carrier with the lowest-cost plan in the same metal tier.
  
  Covered California’s commitment to affordability and access remains unwavering. Its proactive approach to negotiating rates, combined with state subsidies, showcases California’s leadership in advancing the goals of the Affordable Care Act and protecting individuals and families during times of rapidly increasing costs of living.
  
  Shop and switch refers to the average rate change consumers could see if they shop around and switch to the lowest-cost plan in their current metal tier.
  
  Plan options and prices differ depending on the region. For plan information in your area, Covered California recommends comparing plans online on CoveredCA.com. After entering some basic information like your income and location, you can find out what plans are available in your area, what they cover, how much they cost, and what kinds of financial help and programs you may be eligible to receive.
  
  Current Covered California enrollees can choose to renew or switch their plans beginning Oct. 1. You can review your options at any time on
  California
  2027 Rate Changes
  - Fri, 07/17/2026 - 5:01pm
    Before I begin, it's important to note that as in most states, ACA exchange enrollment has plummeted in Michigan since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year: Effectuated enrollment was down 27% year over year as of February, and has almost certainly continued to drop further since then. That's at least 131,000 fewer Michiganders enrolled in ACA healthcare coverage this year.
    
    Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
    
    With that in mind, here's the key points from the 2027 actuarial filings from the various insurance carriers participating in the Michigan individual market next. year (note that Molina is newly entering the Michigan market):
    
    via Alliance Health & Life Insurance Co:
    
    4.3 PROPOSED RATE CHANGES
    
    This filing reflects proposed rates for effective dates of January 1, 2027 through December 31, 2027. We develop premium rates for these Individual plans using AHL’s January 1, 2025 – December 31, 2025 Individual experience, in conjunction with internal research proprietary to AHL and other industry studies and surveys. We consider a number of items in developing the premium rates, including but not necessarily limited to:
    
    Projected morbidity level of the population anticipated to purchase the products
    
    Proposed benefit plan designs
    
    Anticipated medical trend, both utilization and cost of services
    
    Applicable taxes and fees, including those newly applicable since 2014 under ACA
    
    Anticipated risk adjustment payments (receipts)
    
    This memorandum addresses the rate increase requested for AHL’s Individual PPO product, which impacts 2027 renewals. AHL’s total single risk pool has 1,480 members as of February 2026. The rate increase being requested, weighted by current enrollment for AHL’s products, is an aggregate 14.05%. The requested rate increase varies by plan and area with a minimum change of 13.9% and a maximum change of 14.1%. These rates are effective for 12 months beginning January 1, 2027.
    
    Reason for Rate Change
    
    The following are the key drivers of the requested rate change.
    
    Base Experience – AHL’s Individual ACA experience is the basis for AHL’s 2027 premium rates. AHL’s claims experience is driving rate deficiency of 8.3%.
    
    Trend – AHL’s 2027 annual claims trend is approximately 10.2%.
    
    Risk Adjustment – The projected risk adjustment receivable is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by 1.7%.
    
    Retention Charges – The load for retention is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by -6.1%.
    
    via Blue Care Network of Michigan:
    
    BCN is filing a year-over-year average rate increase for 2027 for all individual products that were offered in 2026 of 12.45%. Significant contributors to rate change are outlined in the table below:
    
    Note this is a revised filing and takes into account only information learned subsequent to the original filing, in compliance with DIFS Bulletin 2026-14-INS. Drivers of rate change relative to the initial filing include:
    
    The 2025 experience period used as a starting point for claims projection has been revised according to an additional two months of claims runout relative to the initial filing:
    
    Initial Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through March 31st, 2026
    
    Current Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through May 31st, 2026
    
    Trend in 2026 has been revised to incorporate year-to-date 2026 experience, which has emerged considerably higher than previously projected.
    
    Risk Adjustment has been revised to incorporate new information regarding actual 2025 risk adjustment results, and emerging 2026 morbidity and premium information.
    
    Assumed relative risk levels between BCN and other carriers has been revised based on emerging yearto-date 2026 experience, which has been incorporated into the above mentioned 2026 trend and risk adjustment estimate.
    
    Revisions to incorporate an updated Insurance Provider Assessment of $8.29 PMPM.
    
    The above-mentioned changes encompass only new information that could not have been reasonably known when the rates were originally filed.
    
    Additional detail around the assumptions utilized in the rate development process is included in the following sections of this memorandum.
    
    Although the rates for each product were based on the projected experience for the single risk pool as noted in Section 12 of this memorandum, the rate changes vary by product and plan. While the primary drivers of rate change variation by plan are changes in cost sharing provisions and updates to the Paid to Allowed Ratios as described in Section 8 of this memorandum, changes in network discount and other model changes can also contribute to variations by plan. Rating impacts of ARPA Subsidy expiration are detailed in Section 22.
    
    ...BCN’s individual book of business is projected to decrease by 11.5% from experience period enrollment of approximately 95,000 members in 2025 to approximately 84,000 members in 2027. BCN used 2026 enrollment as the starting point for the 2027 membership projection. The key driver of the membership decrease is the ARPA subsidy expiration, though additional adjustments were made based on marketplace and historical trends as well as actions anticipated by competitor plans.
    
    ...Section 22: ARPA Impact
    
    Impact of enhanced subsidy expiration: We are projecting an approximate 5% increase in rates driven by market morbidity, of which 4% is already realized in 2026.
    
    Impact if enhanced subsidies are restored: We are projecting an approximate 2.5% rate reduction, driven by a decrease in rates due to improved market morbidity. However, we are not projecting a full reversal of the 5% noted above, as members that left the market may not return and there may be other market drivers that we will evaluate at that time. Thus we believe a range of impacts to be between 0% and 5.0%.
    
    via Blue Cross Blue Shield of Michigan:
    
    BCBSM is filing a year-over-year average rate increase for 2027 for all individual products that were offered in 2026 of 12.93%. Significant drivers of the rate change include:
    
    *The geographic coverage impact line represents the impact of discontinuing certain renewing plans within certain rating areas.
    
    Note this is a revised filing and takes into account information learned subsequent to the original filing, in compliance with DIFS Bulletin 2026-14-INS. Drivers of rate change relative to the initial filing include:
    
    The 2025 experience period used as a starting point for claims projection has been revised according to an additional two months of claims runout relative to the initial filing:
    
    Initial Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through March 31st, 2026
    
    Current Filing: Incurred January 1st, 2025 to December 31st, 2025, paid through May 31st, 2026
    
    Trend in 2026 has been revised to incorporate year-to-date 2026 experience, which has emerged considerably higher than previously projected
    
    Risk Adjustment has been revised to incorporate new information regarding actual 2025 risk adjustment results, and emerging 2026 morbidity and premium information.
    
    Assumed relative risk levels between BCBSM and other carriers has been revised based on emerging year-to-date 2026 experience, which has been incorporated into the above-mentioned 2026 trend and risk adjustment estimate.
    
    Revisions to incorporate an updated Insurance Provider Assessment of $8.29 PMPM.
    
    The above-mentioned changes encompass only new information that could not have been reasonably known when the rates were originally filed.
    
    Additional detail around the assumptions utilized in the rate development process is included in the following sections of this memorandum.
    
    Although the rates for each product were based on the projected experience for the single risk pool as noted in Section 12 of this memorandum, the rate changes vary by product and plan. While the primary drivers of rate change variation by plan are changes in cost sharing provisions and updates to the Paid to Allowed Ratios as described in Section 8 of this memorandum, changes in network discount and other model changes can also contribute to variations by plan. Rating impacts of ARPA Subsidy expiration are detailed in Section 22.
    
    ...BCBSM’s individual book of business is projected to decrease by 30.3%, from experience period enrollment of approximately 58,000 members in 2025 to approximately 40,000 members in 2027. BCBSM used 2026 enrollment as the starting point for the 2027 membership projection. The key driver of the membership decrease is the ARPA subsidy expiration, though additional adjustments were made based on marketplace and historical trends.
    
    ...Impact of enhanced subsidy expiration: We are projecting an approximate 5% increase in rates driven by market morbidity, of which 4% is already realized in 2026.
    
    Impact if enhanced subsidies are restored: We are projecting an approximate 2.5% rate reduction, driven by a decrease in rates due to improved market morbidity. However, we are not projecting a full reversal of the 5% noted above, as members that left the market may not return and there may be other market drivers that we will evaluate at that time. Thus we believe a range of impacts to be between 0% and 5.0%.
    
    via Health Alliance Plan:
    
    4.3 PROPOSED RATE CHANGES
    
    This filing reflects proposed rates for effective dates of January 1, 2027 through December 31, 2027.
    
    We develop premium rates for these Individual plans using HAP’s January 1, 2025 – December 31, 2025 Individual experience, in conjunction with internal research proprietary to HAP and other industry studies and surveys. We consider several items in developing the premium rates, including but not necessarily limited to:
    
    Projected morbidity level of the population anticipated to purchase the products
    
    Proposed benefit plan designs
    
    Anticipated medical trend, both utilization and cost of services
    
    Applicable taxes and fees, including those newly applicable since 2014 under ACA
    
    Anticipated risk adjustment payments (receipts)
    
    This memorandum addresses the rate increase requested for HAP’s Individual HMO product, which impacts 2027 renewals. HAP’s total single risk pool has 2,256 members as of February 2026. The rate change being requested, weighted by current enrollment for HAP’s products, is an aggregate 12.60%. The requested rate change varies by plan and area with a minimum change of 12.6% and a maximum change of 12.6%. These rates are effective for 12 months beginning January 1, 2027.
    
    Reason for Rate Change
    
    The following are the key drivers of the requested rate change.
    
    Base Experience – HAP’s Individual ACA experience is the basis for HAP’s 2027 premium rates. HAP’s claims experience is driving rate deficiency of 3.8%.
    
    Trend – HAP’s 2027 annual claims trend is approximately 10.0%.
    
    Risk Adjustment – The projected risk adjustment payable is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by 4.9%.
    
    Retention Charges – The load for retention is increasing relative to the filing approved effective January 1, 2026. This impacts the rate change by -6.2%.
    
    via McLaren Health Plan:
    
    McLaren will sell individual policies with effective date of January 1 st , 2027.
    
    ...The average annual premium for 2027 is $10,328.89, which is $860.74 PMPM (4.21 of URRT WK2 x 12). The average annual premium for 2026 is $8,646.07, which is $720.51 PMPM (2.13 of URRT WK2 x 12). As of March 2026, there are 3,191 policy holders and 4,701 covered lives affected by this proposed rate change. The average overall rate increase is 16.25% (1.12 of URRT WK2).
    
    We have applied an explicit 1.032 morbidity adjustment due to expected market changes based on the expiration of the enhanced Premium Tax Credits (ePTC) made available under the American Rescue Plan Act, as well as additional policy considerations.
    
    ...A morbidity adjustment was applied to 2024 McLaren experience to translate base morbidity to 2027 projected morbidity. We estimated expected differences in the morbidity defined as plan liability risk score (2024 HHS model) normalized by the average induced demand, the average actuarial value, and demographic factor between the base period and the projection period. Because this ratio includes components of age and area, we back out the Step 6 manual demographic adjustment to arrive at a WACA morbidity adjustment shown in Step 7 of Appendix A. An additional morbidity adjustment was made due to reflect the policy adjustment described above. We applied the same adjustment as described in the experience portion of the memorandum.
    
    via Meridian Health Plan of MI:
    
    Reasons for Rate Increase(s):
    
    The rate projections for 2027 have been updated from the previous year’s projections to reflect the most recent assumptions and information available.
    
    The following provides a narrative description of the significant factors driving the proposed rate increase for 2027.
    
    Single Risk Pool Experience and Morbidity (10.8% of premium impact versus 2026 filed rates)
    
    The individual single risk pool experience underlying the rate projections has been updated. The current model reflects the projected utilization trend applied to adjusted experience (from 2025 to 2027), including anticipated changes in the average morbidity of the single risk pool. There is a full description of utilization trend and other projection factors applied to experience in Section 6, ’Trend Factors’.
    
    Risk adjustment transfer experience for 2027 includes consideration of changes to the statewide average premium, the Risk Adjustment program, and Meridian Health Plan of Michigan enrollee population morbidity relative to the Michigan single risk pool.
    
    Unit Cost trend ( 6.5% of premium impact versus 2026 filed rates) Unit costs and provider reimbursement agreements have been updated to reflect changes in the rating year.
    
    Utilization trend ( 3.3% of premium impact versus 2026 filed rates)
    
    The projected utilization trends are consistent with observed historical trends based on internal analysis of our marketplace experience, supplemented by the Milliman Health Cost Guidelines. There is a description of the Health Cost Guidelines in Section 8, "Manual Rate Adjustments".
    
    Changes in Administrative Expenses and Profit ( 2.1% of premium impact versus 2026 filed rates)
    
    Changes in general administrative expenses incorporated into 2027 rates are resulting in a rate change due to differences from prior year expense assumptions. See Section 12, "Plan Adjusted Index Rate", for details on projected non-benefit expenses. Note that the requested rate change may not be the same across all plans within a product due to changes to the member cost sharing amounts by plan. Additionally, the defunding of CSR subsidies has contributed to the rate levels being higher than if the subsidies were to be funded.
    
    ...Impact of eAPTC Expiration
    
    To account for eAPTC expiration prior to the 2027 benefit year, we have assumed rates will increase due to anticipated reductions in enrollment, both at the issuer and single risk pool level. As eAPTCs expire and enrollees subsequently face increased out-of-pocket premiums, we assume healthier individuals who tend to be more price sensitive will leave the market, worsening the average morbidity of the individual risk pool.
    
    via Molina Healthcare of MI:
    
    (newly entering the Michigan market)
    
    This filing assumes CSRs remain unfunded throughout 2027. Rates and assumptions contained herein are no longer actuarially sound if this changes for plan year 2027. If the regulatory environment changes, Molina will work with the state to incorporate changes in an actuarially sound manner.
    
    Molina’s rate filing reflects the following rate changes by metal tier for Molina’s membership. Molina has 0 members in plans that are renewing and 0 members in plans that are terminating for a total of 0 members enrolled effective March 2026 and reported as of April 2026. Similarly, Molina has 0 policyholders in plans that are renewing and 0 policyholders in plans that are terminating for a total of 0 policyholders. The rate change calculation below is consistent with Worksheet 2, Section II of the URRT, which only includes members and policyholders on renewing plans. Since Molina does not have any members for 2026, the rate change result is zero.
    
    The rate changes vary by metal tier due to changes in the Actuarial Value (AV) Pricing Values assigned to each metal plan that are applied to the Plan Adjusted Index Rate.
    
    via Oscar Insurance Co:
    
    3. Proposed Rate Increases Reason for Rate Increase(s)
    
    Exhibit A summarizes the proposed rate increases by plan effective January 1, 2027. Rate increases vary by plan due to a combination of factors including shifts in benefit leveraging, cost-sharing modifications, and geographic rating factors. Using in-force business as of March 2026, the proposed average rate change for renewing plans is 11.9%. This rate change is absent of rate changes due to attained age.
    
    The significant factors driving the proposed rate change are described in the following attribution summary and are displayed quantitatively in Table 1.
    
    Description / Value
    
    Claim Experience in 2025 8.7%
    
    Market Morbidity 3.1%
    
    Medical and Prescription Drug Trend -1.0%
    
    Prospective Benefit Changes -0.1%
    
    Admin, Taxes and Fees, and Risk Margin 1.2%
    
    Total 11.9%
    
    Anticipated Changes in the Average Morbidity of the Covered Population
    
    Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
    
    Medical and Prescription Drug Inflation and Utilization Trends
    
    The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization. Average cost trends were developed based on Oscar’s anticipated reimbursement levels. Utilization trends were developed at the broad service category level: inpatient facility, outpatient facility, professional, other, and prescription drugs.
    
    Prospective Benefit Changes
    
    Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
    
    Administrative Expenses, Taxes and Fees, and Risk Margin
    
    Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
    
    ...Morbidity Adjustment
    
    An adjustment was included to reflect changes in the anticipated market morbidity in response to the uncertainty inherent in the marketplace. Specifically, Oscar anticipated changes to the market morbidity associated with the change in Michigan’s enrollment for the projection period relative to the experience period, due to the ending of the enhanced subsidies introduced by the American Rescue Plan Act, as well as the several new enrollment and eligibility procedures and requirements introduced by regulations including, but not limited to, the 2025 Marketplace Integrity and Affordability Proposed Rule and the HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule.
    
    This adjustment reflects the projected change in claim costs outside of the underlying demographics of the covered population and is also assumed when estimating the risk adjustment transfer for the projection period.
    
    A factor of 1.078 is included in the “Morbidity Adjustment” entry on Worksheet 1, Section II of the URRT
    
    via Priority Health:
    
    The reasons for the rate change include:
    
    Updated experience upon which the rates are based.
    
    Updated medical and prescription Rx cost and utilization trends.
    
    Updated benefit relative values, which may cause variation in rate changes by plan.
    
    Prospective benefit adjustments to existing products; the benefit relative values have been updated, which may cause variation in rate changes by plan.
    
    Anticipated morbidity impact from the continued impacts of EPTC subsidy expiration in 2026.
    
    Anticipated changes in the payments to the Federal Risk Adjustment program incorporating the estimated 2025 Risk Adjustment Transfer Payment.
    
    Updated factors for administrative expenses and margin. With this filing, the margin varies by plan.
    
    Updated taxes and fees.
    
    Updated Silver CSR Load.
    
    The overall average annual increase which will be experienced by members over January 1, 2026 filed rates is an 11.08% increase.
    
    via UnitedHealthcare Community Plan:
    
    UHC will sell Individual policies with an effective date of January 1, 2027. The 2027 aggregate rate change as shown on the Unified Rate Review Template (URRT) is 25.54%. Rate changes by plan are found in Worksheet 2, row 1.11 of the URRT. The quantitative impact for all significant factors driving the proposed rate change is shown in the table below.
    
    Components of Rate Change / % Change
    
    Base Experience 6.9%
    
    Trend 11.4%
    
    Regulatory Morbidity 2.5%
    
    Benefit Design and CSR Load 4.6%
    
    Non-Benefit Expenses -1.4%
    
    Other -0.3%
    
    Total 25.54%
    
    EXPIRATION OF ENHANCED SUBSIDIES
    
    A 1.173 adjustment was applied to account for the expiration of enhanced premium subsidies passed under the American Rescue Plan Act (ARP) and extended by the Inflation Reduction Act (IRA). Due to the expiration of the enhanced premium subsidies effective 1/1/2026, UHC observed a decline in enrollment due to higher post-subsidy premiums. Healthier members are expected to leave at a disproportionately higher rate than those with significant healthcare needs, increasing market morbidity in 2026. This estimate is based on internal modeling using historical Wakely National Risk Adjustment Reporting (WNRAR) data, Marketplace Open Enrollment Period Public Use Files, and Wakely Early Enrollment Reporting for 2026
    
    Put them all together and you get the following, although according to the
    
    Michigan
    2027 Rate Changes
    Mon, 07/13/2026 - 4:35pm
    
    Medica will no longer offer individual marketplace plans in Iowa, Kansas and Oklahoma, effective January 1, 2027.
    
    The decision affects about 4,000 members in Iowa, 600 members in the Kansas City area in Kansas, and 8,400 members in Oklahoma, the company confirmed to Becker’s. The insurer will continue to offer marketplace coverage in Minnesota, Missouri, Nebraska, North Dakota and Wisconsin.
    
    “Members currently enrolled in Medica individual products in these states will continue to receive benefits until their renewal date,” a Medica spokesperson said. “Medica’s strategic focus is to ensure we remain competitive in markets where we can deliver value by simplifying offerings, reducing overlap, and prioritizing high-value provider partnerships.”
    
    This puts Iowa's total ACA-compliant individual market at around 104,000 people total as of spring 2026, with preliminary weighted average 2027 rate increases of around 6.7%...the second-lowest statewide average I've seen so far, after Vermont's 6.5% average:
    
    Avera Health Plans:
    
    1. SCOPE AND RANGE OF RATE INCREASE
    
    Avera Health Plans, Inc. (Avera) is requesting a rate increase for the Avera MyPlan individual products for Iowa with an effective date of January 1, 2027. The requested overall rate increase impacts approximately 438 members. The rate increase being requested for the Avera MyPlan products is 14.8% averaged across all members. Rate changes vary by plan due to changes in cost sharing parameters (e.g., deductible, coinsurance, copays) relative to 2026 cost sharing parameters, ranging from 12.3% to 21.7% by plan.
    
    2. FINANCIAL EXPERIENCE
    
    There is no historical financial experience to report as Avera entered the Iowa individual market on January 1, 2026. The financial experience for Avera’s South Dakota individual ACA-compliant experience, which supports manual rate projections in Iowa, was unfavorable in 2025 relative to the 2024 experience used to develop 2026 rates.
    
    3. CHANGES IN MEDICAL SERVICE COSTS AND TREND ASSUMPTIONS
    
    To capture the increasing cost and utilization of medical services, projections from manual rate experience assume 6.7% annual trend. This assumption is based on analysis of regional and national trends and actuarial judgment.
    
    4. CHANGES IN BENEFITS
    
    Avera will make cost sharing modifications by plan to comply with the final 2027 Actuarial Value Calculator and based on 2027 strategic considerations. To the extent the plan changes lead to a higher or lower level of benefit richness, the premium rates would increase or decrease, respectively.
    
    5. ADMINISTRATIVE COSTS AND ANTICIPATED PROFITS
    
    Avera is targeting a loss ratio of 86.5% for its individual block of business in January 2027. This loss ratio allows 13.5% for total health plan administrative costs, taxes, fees, and anticipated profits.
    
    6. EXPIRATION OF EXPANDED ADVANCE PREMIUM TAX CREDIT SUBSIDIES
    
    Avera expects the expiration of expanded Advance Premium Tax Credit subsidies will result in higher market morbidity due to the anticipated mix of enrollees remaining in the market.
    
    IOWA TOTAL CARE:
    
    Iowa Total Care is filing rates for the individual block of business, effective January 1, 2027. This document is submitted in conjunction with the Part I Unified Rate Review Template and the Part III Actuarial Memorandum.
    
    This information is intended for use by the Iowa Insurance Division, the Center for Consumer Information and Insurance Oversight (CCIIO), and health insurance consumers in Iowa to assist in the review of Iowa Total Care’s individual rate filing.
    
    The results are actuarial projections. Actual experience will differ for a number of reasons, including population changes, claims experience, and random deviations from assumptions.
    
    In 2025, earned premium was $517.11 per member per month (PMPM). Incurred claims in 2025 were $363.50, or 70.29% of premium. Netting risk adjustment from the claims results in an estimated loss ratio (incurred claims net of estimated risk adjustment transfers, divided by earned premiums) of 80.67%. We expect unit costs to increase for 2027. Further, we have updated underlying experience for the single risk pool, expected administrative expense, and assumptions for federal risk adjustment. These factors, as well as changes to the assumed morbidity of the single risk pool and medical trend, result in a premium rate increase.
    
    Medical trend, or the increase in health care costs over time, is composed of two components: the increase in the unit cost of services and the increase in the utilization of those services. Unit cost increases occur as care providers and their suppliers raise their prices. Utilization increases can occur as people seek more services than before. Additionally, simple services can be replaced with more complex services over time, which is known as service intensity trend. An example of service intensity trend would be the replacement of an X-ray with an MRI scan. Replacing the service with a more intense service causes the total cost of medical services to increase.
    
    The proposed rate change of 16.8% applies to approximately 6,982 individuals. Iowa Total Care’s projected administrative expenses for 2027 are $100.80 PMPM. Administrative expense does not include $19.87 for taxes and fees. The historical administrative expenses for 2026 were $81.57 PMPM, which excludes taxes and fees. The projected loss ratio is 81.0% which satisfies the federal minimum loss ratio requirement of 80.0%.
    
    OSCAR INSURANCE CO:
    
    1. Scope and Range of Rate Increase
    
    The purpose of this document is to present rate change justification for Oscar Insurance Company, Inc (Oscar’s) Individual Affordable Care Act (ACA) products, with an effective date of January 1, 2027, and to comply with the requirements of Section 2794 of the Public Health Service Act as added by Section 1003 of the Patient Protection and Affordable Care Act (ACA).
    
    Using in-force business as of March 2026, the proposed average rate increase for renewing plans is 11.9%. Rate increases vary by plan and range from 4.6% to 28.2% due to a combination of factors including shifts in benefit leveraging and cost-sharing modifications and network changes. This rate increase is absent of rate changes due to attained age. There are 11,971 current members impacted by this rate increase.
    
    2. Reason for Rate Increase(s)
    
    The significant factors driving the proposed rate change include the following:
    
    Medical and Prescription Drug Infl ation and Utilization Trends
    The projected premium rates reflect the most recent emerging experience which was trended for anticipated changes due to medical and prescription drug inflation and utilization.
    
    Administrative Expenses, Taxes and Fees, and Risk Margin
    Changes to the overall premium level are needed because of required changes in federal and state taxes and fees. In addition, there are anticipated changes in both administrative expenses and targeted risk margin.
    
    Prospective Benefit Changes
    Plan benefits have been revised as a result of changes in the Center for Medicare and Medicaid Services (CMS) Actuarial Value Calculator and state requirements, as well as for strategic product considerations.
    
    Anticipated Changes in the Average Morbidity of the Covered Population
    Changes to the overall premium level are needed because of anticipated changes in the underlying morbidity of the projected marketplace.
    
    Anticipated Changes in the Network Configuration
    Changes to the overall premium level are needed because of anticipated changes in the underlying network configuration and associated unit costs.
    
    UNITEDHEALTHCARE OF THE RIVER VALLEY:
    
    Scope and Range of the Rate Increase
    
    UHCPRV is filing 2027 rates for individual products. The proposed rate change is 11.77% and will affect 546 individuals. The rate changes vary between 9.66% and 12.53%. Given that the rate changes are based on the same single risk pool, the rate changes vary by plan due to plan design changes.
    
    Financial Experience of the Product
    
    The premium collected in plan year 2025 was $3,966,129. Incurred claims during this period were $3,070,089 and UHCPRV expects payments of $42,830 for risk adjustment. The loss ratio, or portion of premium required to pay medical claims, for plan year 2025 is 78.49%.
    
    Changes in Medical Service Costs
    
    There are many different healthcare cost trends that contribute to increases in the overall U.S. healthcare spending each year. These trend factors affect health insurance premiums, which can mean a premium rate increase to cover costs. Some of the key healthcare cost trends that have affected this year’s rate actions include:
    
    Increasing cost of medical services: Annual increases in reimbursement rates to healthcare providers, such as hospitals, doctors, and pharmaceutical companies.
    
    Increased utilization: The number of office visits and other services continues to grow. In addition, total healthcare spending will vary by the intensity of care and use of different types of health services. The price of care can be affected using expensive procedures such as surgery versus simply monitoring or providing medications.
    
    Higher costs from deductible leveraging: Healthcare costs continue to rise every year. If deductibles and copayments remain the same, a higher percentage of healthcare costs need to be covered by health insurance premiums each year.
    
    Impact of new technology: Improvements to medical technology and clinical practice often result in the use of more expensive services, leading to increased healthcare spending and utilization.
    
    Legislative & regulatory changes: Premiums reflect an increase in projected average cost per member driven by adverse morbidity impacts associated with the expiration of enhanced APTCs and changes in federal premium subsidy eligibility.
    
    WELLMARK HEALTH PLAN OF IA:
    
    Scope and Range of Rate Increase
    
    Wellmark Health Plan of Iowa, Inc. (Wellmark) has requested an average rate increase of 5.0% for ACA-compliant policies effective January 1, 2027. Rate increases vary by plan, ranging from -2.3% to 10.7%, and do not include rate changes due to age of the members on the policy. As of March 31st, 2026, there are approximately 80,000 individual members in the pool. Most of the members in the pool are eligible for a premium subsidy and may not experience a post-subsidy rate change within the range above.
    
    Financial Experience of the Product
    
    Wellmark anticipates 2026 experience will be worse than the target loss ratio. Applying the requested rate increases, Wellmark projects a loss ratio of 89% for this block of business in 2027. It should be noted that the projected Medical Loss Ratio (MLR) meets the minimum requirement of 80% defined in the ACA.
    
    Changes in Medical Service Costs
    
    Annual trend of 4.5% was used to project claims from the experience period into the rating period and drives rates up for 2027. This trend assumption includes changes in service costs and utilization.
    
    Changes in Benefits
    
    Plan design changes were made to Wellmark’s 2027 product offerings. These changes drive rates down for 2027. Rate changes provided above incorporate the impact of plan design changes.
    
    Administrative Costs and Anticipated Profits
    
    The main drivers of administrative expenses are employee salaries and benefits, broker and agent commissions, and various governmental taxes and fees. Wellmark strives to maintain a low administrative expense as a percent of premium, as well as the underlying cost of care, in order to provide the best value to our customers. With a decrease to the Exchange User Fee, smaller government fees in 2027 are driving rates down.
    
    American Rescue Plan Enhanced Subsidy Expiration
    
    The enhanced subsidies afforded in the American Rescue Plan expired in 2026. Wellmark anticipates this change will result in worse market risk, driving rates up.
    
    Iowa
    2027 Rate Changes
    Medica
    Mon, 07/13/2026 - 1:09pm
    Hoo boy. they announced they were pulling out of the entire individual market nationally earlier this year. I don't know how many Georgians are enrolled in Cigna plans at the moment, but it was around 35,000 as of a spring 2025.
    
    Peach State Health Plan (by Centene) also appears to be dropping out of the GA market, although they were always just a subsidiary of Ambetter of Peach State anyway. This gets a bit confusing since they so I'm not entirely sure what the situation is. In any event, they only had around 3,000 enrollees as of spring 2025.
    
    One carrier is newly entering the Georgia individual market, however: Antidote Health of GA.
    
    Beyond that, as I said, it's a pretty ugly state of affairs. In 2025, over 1.5 million Georgians signed up for ACA plans during Open Enrollment, with an average of around 1.3 million actually enrolled in coverage per month. This year, only ~1.3 million signed up to begin with, actual enrollment was below 1.2 million by February, and it had reportedly dropped to around 950,000 as of April.
    
    The actual rate filings suggest it may be even worse than that: They only total around 920,000 people as of March/April 2026 including off-exchange enrollment...possibly breaking 950,000 if you assume that both Cigna and Peach State's enrollees were still as high as they had been a year earlier, which is unlikely.
    
    In any event, the insurance carriers participating next year are requesting full price average rate increases ranging from 16.9% (BCBS of GA) to as high as a stunning 54.3% (UnitedHealthcare)...with a weighted average around 20.7% higher than the current premiums are.
    
    If approved as is, this would amount to unsubsidized enrollees paying another $1,925/year apiece on in premiums alone on average on top of the massive hikes they're seeing this year.
    
    Georgia
    2027 Rate Changes
    Fri, 07/10/2026 - 4:55pm
    about 100,000 Virginians have lost their health coverage this year as a result of higher premiums, according to a new press release.
    
    “Most Virginians losing Marketplace coverage this year do not have any other options for health insurance coverage,” exchange director Keven Patchett said. “The new affordability program will go a long way toward helping to ease the cost burden, allowing more Virginia families to enroll in and maintain high-quality health coverage.”
    
    The program targets Virginia households with incomes between 138% and 250% of the federal poverty level, which represents about 45% of people in the state who have lost their coverage this year, according to state data.
    
    While some consumers enrolled in lower-tier plans with lower premiums, others were priced out or canceled their plans after a few months. Overall, enrollment dropped by 20% compared to last summer, the state exchange reported.
    
    The funds will be available for eligible Virginians to tap into starting November 1 through Dec. 31.
    
    First off, the phrasing of the highlighted snippets is a bit confusing, but:
    
    Effectuated ACA coverage was 362,514 as of June 2025 & 363,848 as of July 2025. A ~20% drop from either of those puts current effectuated enrollment at around ~290,000 people as of June/July 2026.
    
    This is actually only a net drop of around ~72,000, not ~100,000. The discrepancy is presumably because that ~100K figure doesn't include other Virginians who weren't previously enrolled who have gained coverage this year.
    
    In any event, assuming that the "20% drop" compares June 2026 to June 2025, here's what that looks like visually:
    
    This also means that the monthly average VA ACA enrollment is down around 46,000 people so far this year, or ~12.7%:
    
    As for the new state subsidies, $150 million is actually pretty generous, but it still wouldn't fully replace all of the lost federal tax credits. According to an analysis by the state itself last fall, they'd have to come up with Virginia's unsubsidized premiums have shot up over 20% this year, meaning it takes more funding to cover the gap of the lost tax credits for the same number of people than it did last year.
    
    Regardless, this is still excellent news for the ~200,000 lower-income Virginians...assuming they can survive until January 1st, 2027, that is...
    
    Virginia
    SBMs
    State-baed Exchanges
    VA Insurance Marketplace
    State Subsidies
    Wed, 07/08/2026 - 1:58pm
    Yesterday I noted that the Centers for Medicare & Medicaid Services (CMS) has published a new database which updates the official effectuated ACA exchange enrollment data for all 50 states (+DC) through February 2026.
    
    This means that I finally have comprehensive effectuated enrollment data for the first two months of the year for every state, as opposed to only having Open Enrollment Period (OEP) plan selections, which aren't the same thing.
    
    While there are still four months of effectuated enrollment data missing, this still fills in a lot of the missing pieces of the year over year enrollment puzzle, since this new database also includes state-level effectuations from August - December 2025 as well (previously I only had the national total for those months).
    
    In addition, there's several states which provide their own monthly enrollment reports...although those numbers don't always match up perfectly with the official CMS reprots, since there can be differences in methodology, "as of" dates and so on. I'll get more into that below.
    
    First, however, here's a table breaking out just how many Americans were enrolled in ACA exchange healthcare coverage as of February 2026 compared to one year earlier in February 2025:
    
    Nationally, effectuated enrollment has dropped by more than 2.6 million people year over year...with the vast bulk of this being found in states hosted by the federal exchange, while the state-based exchanges saw a smaller reduction (important caveat: Illinois switched from the federal exchange (HealthCare.Gov) to its own state-based exchange last fall, which skews the breakout for each category a bit; I'm counting IL as a SBE for purposes of this breakout).
    
    Update: The 2025 FFM & SBE subtotals above have been corrected.
    
    At the state level, there are 15 states which saw year over year enrollment drop by 20% or more: AL, AZ, IN, KS, LA, MI, MN, MS, MO, NE, NC, OH, OK, SC & WY. The biggest percentage drops were OHIO and OKLAHOMA, where February enrollment was more than 30% lower in 2026 than in 2025.
    
    By contrast, there's exactly one state which saw a net increase in effectuated enrollment as of February: NEW MEXICO, which accomplished this thanks to the state fully backfilling 100% of all lost federal tax credits for 100% of their enrollees. They're they only state to pull this off, although several other states are covering all or at least some of the lost subsidies for a portion of their enrollees. As a result, New Mexico's effectuated enrollment as up a whopping 14.5% as of February...although even this still shows a bit of a drop from the OEP tally (2026 OEP selections were 17% higher than they were during the 2025 OEP).
    
    While no other states were up year over year, there were several which saw drops of 5% or less as of February, including CT, DC, ID, IL, MA, PA, RI & TX. Connecticut and Massachusetts provide their own supplemental state financial subsidies, while Illinois, Pennsylvania and Texas all have robust Premium Alignment pricing policies which are helping mitigate the financial damage and limiting the enrollment losses.
    
    Here's another way of looking at the data: This table compares effectuated coverage in each state as of February against the same number in January as well as the plan selection tally during the 2026 Open Enrollment Period itself, to give an idea of how misleading that initial OEP figure was (which, again, was already ~1.2 million lower than it was during the 2025 OEP):
    
    When you look at it this way, the drop is even more stark: Nationally, effectuated enrollment had dropped over 17% from the OEP total (which, again, was already down ~1.2 million from a year prior). That's nearly 4 million fewer actually enrolled in healthcare coverage than the official OEP plan selection report indicated.
    
    At the state level, this ranges from only 3.7% lower in New Mexico to a stunning 39% drop in Mississippi. Sixteen states have seen their enrollment plummet by 20% or more apiece, five of which are down over 30% vs. the end of Open Enrollment.
    
    Unlike my "cost analysis" series which I just wrapped up yesterday, I'm not going to create 51 separate blog posts about this data; instead, I'm going to highlight a few of the more noteworthy states.
    
    First up, here's the five states which saw the sharpest decline from OEP through February 2026: OK, IN, LA, SC & MS:
    
    Next, here's the five states which have seen the smallest drop from 2026 OEP through later in the year...and again, thanks to all five of these providing their own regular effectuation reports, I have data from March or later for each of them. It's also worth noting that four of these five states provide supplemental state subsidies to some (or all in the case of New Mexico) of their ACA enrollees:
    
    California: down just 7.3% vs. the OEP total).
    
    Connecticut: down just 3.1% vs. the OEP total).
    
    Nevada: According to a Plurbius News article from May 22nd, Nevada's effectuated enrollment had dropped by 11.5% since the OEP total as of May 1st.
    
    New Mexico: down 10.2% from OEP.
    
    Vermont: According to the same Plurbius News story, Vermont's effectuated enrollment stood at 28.5K as of April, down 6.0% from the OEP tally.
    
    CMS
    ACA
    Effectuated Enrollment
    Tue, 07/07/2026 - 12:26pm
    A year and a half ago, just one day before Donald Trump was sworn in as President for the second time, I posted the a passage from near the beginning of George Orwell's 1984:
    
    But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
    
    For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.
    
    Very likely no boots had been produced at all. Likelier still, nobody knew how many had been produced, much less cared. All one knew was that every quarter astronomical numbers of boots were produced on paper, while perhaps half the population of Oceania went barefoot. And so it was with every class of recorded fact, great or small. Everything faded away into a shadow-world in which, finally, even the date of the year had become uncertain.
    
    my early fears proved to be disturbingly accurate, as the Trump Regime began purging terrabytes of data from dozens of official federal Health & Human Services Dept. websites, including the CDC, FDA and NIH. It got so bad that I archived the entire public-facing versions of all three of these sites...and even threw in the site for the Centers for Medicare & Medicaid Services (CMS) itself for good measure.
    
    If you use public data products from the CDC or other US federal agencies Download them NOW [This is how I’m spending my Friday]
    
    From a journalist friend: Just spreading the word. The CDC is purging data, so people should archive their favorite CDC datasets today, namely ones around race/ethnic diversity, LGBTQ, and reproductive health. Also health data involving climate. The youth risk behavior survey has already gone down.
    
    Things got even worse once Elon Musk and his DOGE Hitler Youth Incel Brigade were given free rein and As I kept stating month after month:
    
    It's also noteworthy that these numbers are being officially recognized by the Musk/Trump admin under the circumstances.
    
    ...As for my concerns about potential manipulation of data by the Musk/Trump Admin, once again I'm still not seeing any obvious red flags in this month's report.
    
    Again, I'll continue to keep a close eye on this, but it doesn't look like Musk/Trump's CMS are messing with this data as of yet.
    
    I also kept posting the following postscript to the monthly Medicare reports:
    
    It's also worth noting that, given the Musk/Trump Admin's obsession with erasing any reference or data regarding gender, race or ethnicity, the Medicare enrollment reports still include breakouts of those demographic factors.
    
    Now, it's entirely possible that the Trump Regime simply hasn't gotten around to messing with this particular data, or that they've determined that doing so would be a bridge too far (hah!), but for whatever reason, so far at least, they've been publishing Medicare, Medicaid & CHIP enrollment reports on monthly basis...and, just as importantly, so far I haven't seen anything in any of the data which has raised any red flags about the books being cooked.
    
    This brings me to today's development. While CMS has regularly published official state-level (sometimes county-level) enrollment reports for Medicaid, CHIP and Medicare for years, when it comes to Affordable Care Act enrollment data, it's always been somewhat spotty.
    
    During the official Open Enrollment Period (OEP) itself, which has ran anywhere from 75 days to 197 days depending on the year (the 2026 OEP ran 107 days in most states but as long as 123 days in a few), CMS has typically published "Snapshot Reports" either once a week or once every other week which include data about how many people in every state select exchange coverage. As I've noted many times, however, that's not the same thing as the number of people with effectuated coverage.
    
    About half of the states which operate their own ACA exchanges, such as California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New Mexico and New York typically publish monthly (or near-monthly) effectuated enrollment reports throughout the year. For most states, however, I usually have to rely on just two or three reports published by CMS:
    
    Every spring, usually in late March, they'll publish the official OEP ACA Marketplace Public Use File, which includes lots of detailed demographic data...except again, this includes everyone who selected plans during OEP, not those who have effectuated coverage, which is always somewhat smaller.
    
    Later in the year, typically sometime over the summer, they'll usually publish an "
    
    Towards the end of the year, they might (or might not) post another Public Use File which includes which appears to be identical to the monthly Medicaid/CHIP and Medicare enrollment reports, but specifically for effectuated ACA exchange enrollment!
    
    Assuming this is true, it's a genuinely good thing for data transparency which will also make my life easier...although there's one caveat which I'll address below.
    
    But first, let's take a look at the new database:
    
    The Health Insurance Exchanges Monthly Effectuated Enrollment data provide select metrics on monthly effectuated enrollment across the Federally Facilitated Exchange (FFE) and State‑Based Exchanges on the Federal Platform (SBE‑FPs), which both use the federal enrollment platform (HealthCare.gov), as well as State‑Based Exchanges (SBEs) that operate their own eligibility and enrollment platforms.
    
    These metrics include effectuated enrollment counts by state, exchange platform type, year and month.
    
    Resources for Using and Understanding the Data
    
    The data are gathered from the Centers for Medicare and Medicaid Services Enrollment and Payment System (EPS), which serves as a central repository for capturing, organizing, aggregating, and analyzing payment data for the FFE, SBE-FP and SBE Exchanges. Effectuated enrollment data reflect the date of retrieval from the EPS. Please see the Methodology for more information on posting schedule and data availability.
    
    Sure enough, when I download the actual data set, it provides effectuated ACA exchange enrollment for all 50 states (+DC) for every month from every year starting in 2016...all the way up through February 2026.
    
    Unfortunately, it still doesn't include this data for the first two years that the ACA exchanges were operating (2014 & 2015), but this is still an extremely valuable resource which helps fill in some of the gaps in my existing data, and which will prove highly useful going forward assuming they do in fact update it on a monthly basis (also assuming, of course, that the data is accurate).
    
    Until now, I was missing both national and state-level effectuation data from August 2025 onward, as well as national data for January 2026. I have state level data for the states which publish their own monthly reports, but nothing for most states.
    
    This new database fills in both national and state-level data for August 2025 - February 2026...while also making modifications to the monthly data from 2025.
    
    I'll get into the state-level data in future posts, but for now, here's what it looks like at the national level:
    
    Here's where things may get a little confusing, as there's three different ways of measuring effectuated enrollment:
    
    OEP QHPs: The total number of people who selected ACA exchange healthcare policies during the annual Open Enrollment Period
    
    Monthly Effectuated Enrollees: The number of people enrolled in effectuated (ie, in effect) coverage for that specific month
    
    Average: The monthly average number enrolled in effectuated coverage for every month to date.
    
    This is why, for instance, the headline in my own piece about last weeks ASPE report noting that effectuated enrollment had dropped to ~19.2 million nationally referred to a year over year drop of 2.6 million people, while over at NOTUS,
    You can also see the trend line starting to form already by looking at the last column:
    
    OEP plan selections dropped by 4.8% from OEP 2025 to OEP 2026 (down ~1.2M)
    
    Effectuated enrollment as of January 2026 was nearly double that rate: Down 9.1% compared to January 2025 (down ~2.0M)
    
    Effectuated enrollment as of February 2026 was down by even more: 12.0% compared to February 2025 (down ~2.6M)
    
    Based on the more recent enrollment data I've seen from 15 states so far, I'm pretty certain that the downward trend has only continued nationally as more and more enrollees have been unable to keep up with the 58% higher (on average) premiums.
    
    Here's what this looks like visually, updated to include the official national CMS data for August 2025 - February 2026 (I'm not including 2014 - 2018 as that makes the graph too cluttered).
    
    As you can see, I've included projections for the remaining 10 months of the year assuming that it follos the same pattern as 2025 or the same pattern as 2019. If it follows the 2025 pattern going forward, around 2.6 million fewer people will be enrolled on average for the full year...roughly the same as where things stand today.
    
    If, however, it follows the 2019 pattern (I use 2019 because that was the last pre-COVID year), then effectuated enrollment will continue to drop off and will end up at around ~18.1 million by December...which would mean nearly 4.0 million fewer people enrolled each month on average.
    
    Unfortunately, I strongly suspect that even this is an optimistic scenario, and that the actual pattern will be an even sharper drop-off. We could be looking at as many as 6 million Americans losing ACA healthcare coverage on average in calendar year 2026.
    
    That brings me to the caveat I mentioned earlier...the modifications to 2025 effectuated enrollment data included in the new database numbers.
    
    Here's a side by side comparison of the national monthly effectuated enrollment data according to three different official CMS public use files:
    
    (published November 2025; data thru July 2025)
    
    As you can see, the effectuated total was lower for each month according to the November report than it was in the July report...and today's new database has the numbers dropping even further yet.
    
    While it's understandable to be concerned that the Trump Regime playing with the numbers, this does pass the smell test for me, for three reasons. First, each month.
    
    In addition, I went back and checked the years prior to 2025 and the new ACA effectuated enrollment database doesn't make a single change to any of those--the numbers for every month are identical.
    
    The final reason I'm pretty confident that this data is legitimate (at least so far) is that while the drop may look significant (July 2025 is over 200,000 lower in the new database than it was in the November spreadsheet), it's actually close to a rounding error for most months, ranging from 0.23% to 0.95% lower depending on the month.
    
    Anyway, I'll be keeping a close eye on the data in this new resource and will note if it seems to be out of line with what I'd expect (as well as other data sources such as the ~20 state-based exchanges themselves), but for the moment, I welcome this development.
    
    CMS
    ACA
    Effectuated Enrollment
    Medicaid
    CHIP
    Medicare
    Effectuation Report

ACA Signups

CMS posts April 2026 Medicare data; 70.3 million total

CMS posts March 2026 enrollment report: ~5.2 MILLION fewer Americans have Medicaid/CHIP coverage since Trump returned