ACA (Obamacare) marketplace effectuated enrollment shows steep drop in U.S. and in Missouri
New federal data on effectuated (paid) enrollment in ACA (Obamacare) marketplace plans shows large 12% drop across U.S. and 25% drop in MO; lowest levels in MO since August 2023
July 2026 — Earlier data released by the federal showed a significant drop of close to 5% in “signups” for marketplace plans using the Affordable Care Act (ACA)’s marketplace platform and a larger 12% drop in Missouri. However, analysts warned that this may not be the end of the story, since those who sign up for a marketplace plan may not keep the plan, that is, pay the premiums once they realize how expensive the plans are and consider their ability to afford the plans.
The drop in enrollment is happening in part because recipients are facing significant increases in marketplace premiums, resulting from a decision made by the Congress not to renew the enhanced premium tax credits (EPTCs) at the end of 2025. A large drop in enrollment had been predicted before Congress decided not to extend the EPTCs by the Congressional Budget Office (CBO), which predicted that almost 4 million people would make the decision to drop their marketplace plans if the EPTCs were not extended in 2026.
New data released by CMS shows that a significant number of people who signed up for plans did not “effectuate” their plan. In summary:
Nationwide, effectuated enrollments in ACA marketplace plans are 19.2 million in February 2026, down 12% from February 2025 when 21.8 million had effectuated ACA plans.
Across all months in 2025, the number with effectuated enrollment was 22.1 million, as enrollment fluctuates from month to month (see graph).
In Missouri, effectuated enrollments in ACA marketplace plans are 260,999 in February 2026, down 25% from February 2025 when 347,424 had effectuated ACA plans.
Across all months in 2025, the number with effectuated enrollment was roughly 357,900 in Missouri, as enrollment fluctuates from month to month (see graph).
The level of effectuated enrollment in ACA marketplace plans in Missouri is the lowest level seen since August 2023.
A map released by Axios shows the variation in how effectuated enrollment changes varies across the states:
The biggest drops in effectuated ACA enrollments have been observed in Ohio, Oklahoma, Arizona, South Carolina and Minnesota. Ohio and Oklahoma lost nearly a third of their enrollment. Missouri was also among the states losing a large percentage of enrollees (25% or more).
Enrollment dropped at much lower levels in some states and even increased in New Mexico, primarily because the state chose to use their own dollars to help offset the loss in federal subsidies.
Source: Axios, 7/6/26, https://www.axios.com/2026/07/07/where-obamacare-enrollment-is-plummeting
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Report prepared by analysts from the Bursky School of Public Health, Washington University in St. Louis, and Center for Advancing Health Services Policy and Economics Research (CAHSPER) at WashU. Views of the authors alone.