Before I begin, it's important to note that ACA exchange enrollment has dropped in Pennsylvania since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year...although thanks to the state implementing fairly robust Premium Alignment pricing, it's not nearly as dramatic a drop-off as in most other states.
Initial signups during Open Enrollment were actually slightly higher than last year...but effectuated enrollment began to drop starting in February and has continued to drop at an increasing rate every month since then. As of July 2026, effectuated enrollment is down more than 10% vs. a year earlier, and it's down nearly 4% on average for the year so far. That's 48,000 fewer Pennsylvanians with ACA exchange coverage as of July:
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.
Covered California, the state's ACA exchange, has published effectuated enrollment data for January & February 2026, so it's time to dig in and see what this might say about national trends.
Officially, Qualified Health Plan (QHP) selections during Open Enrollment were only 2.6% lower than they were in 2025. However, as I expected and have warned about repeatedly, the year over year drop in effectuated enrollment was higher than that in January (down to 1,839,000, a 2.8% drop y/y), and the gap more than tripled in February:
As I've noted before: While I include the passive/auto-renewal number for completeness sake, that number won't really be relevant until after the deadline for January 1st coverage passes (which isn't until New Year's Eve in California).
More important for the moment is the total number of active enrollments, which includes both new enrollees as well as current enrollees who log into their account and actively select a plan for 2026.
In California, those come to 617,316 combined.
As of the same point last year (actually 1 day more; the data from last year is as of 12/28), Covered CA was reporting:
