States ranked by ACA enrollment change since 2025 – Becker’s Payer Issues

New Mexico has seen the most important improve in ACA enrollment from 2025 to 2026, whereas North Carolina has seen the most important lower, in keeping with KFF.

The rating beneath makes use of preliminary CMS information evaluating comparable intervals throughout the 2025 and 2026 open enrollment intervals. The figures don’t embrace last enrollment totals for both yr.

The 2026 information consists of plan picks by means of Jan. 3 for federally-facilitated marketplaces and state-based marketplaces utilizing HealthCare.gov, and thru Dec. 27 for state-based marketplaces. Idaho is an exception, the place open enrollment ran from Oct. 15 by means of Dec. 15.

The 2025 information consists of plan picks by means of Jan. 4, 2025, for federally-facilitated marketplaces and state-based marketplaces utilizing HealthCare.gov, and thru Dec. 28, 2024, for state-based marketplaces.

As of Jan. 3, nationwide market enrollment stood at almost 22.8 million, down about 3.5% from 2025.

States ranked by ACA enrollment change from 2025 to 2026:

1. New Mexico: 19.5%
2. District of Columbia: 9.7%
3. Texas: 6.5%
4. Maryland: 6.2%
5. Massachusetts: 5%
6. Connecticut: 3.8%
7. Louisiana: 3.4%
8. New Jersey: 3.2%
9. Idaho: 2.6%
10. California: 2.1%
11. Pennsylvania: 1.3%
12. Rhode Island: 0.9%
13. Vermont: -0.8%
14. Colorado: -0.9%
15. Illinois: -0.9%
16. Virginia: -2.1%
17. Kansas: -2.4%
18. Nevada: -2.5%
19. Arkansas: -2.6%
20. North Dakota: -3.2%
21. New York: -3.3%
22. Florida: -3.4%
23. Montana: -3.4%
24. Alabama: -3.5%
25. Hawaii: -3.6%
26. Nebraska: -4%
27. Minnesota: -4.2%
28. Michigan: -4.8%
29. Washington: -4.9%
30. New Hampshire: -5.3%
31. Wisconsin: -5.6%
32. South Dakota: -5.8%
33. Kentucky: -6.1%
34. South Carolina: -6.6%
35. Utah: -6.9%
36. Mississippi: -7%
37. Maine: -7.7%
38. Alaska: -8.3%
39. Iowa: -8.4%
40. Wyoming: -8.5%
41. Missouri: -11.3%
42. Tennessee: -11.3%
43. Georgia: -12.8%
44. Arizona: -13.8%
45. Oregon: -14.1%
46. Oklahoma: -14.4%
47. Delaware: -14.7%
48. Indiana: -14.7%
49. West Virginia: -15%
50. Ohio: -18.6%
51. North Carolina: -21.1%