New Mexico has seen the biggest increase in ACA enrollment from 2025 to 2026, while North Carolina has seen the largest decrease, according to KFF.
The ranking below uses preliminary CMS data comparing similar periods during the 2025 and 2026 open enrollment periods. The figures do not include final enrollment totals for either year.
The 2026 data includes plan selections through Jan. 3 for federally-facilitated marketplaces and state-based marketplaces using HealthCare.gov, and through Dec. 27 for state-based marketplaces. Idaho is an exception, where open enrollment ran from Oct. 15 through Dec. 15.
The 2025 data includes plan selections through Jan. 4, 2025, for federally-facilitated marketplaces and state-based marketplaces using HealthCare.gov, and through Dec. 28, 2024, for state-based marketplaces.
As of Jan. 3, national marketplace enrollment stood at nearly 22.8 million, down about 3.5% from 2025.
States ranked by ACA enrollment change from 2025 to 2026:
- New Mexico: 19.5%
- District of Columbia: 9.7%
- Texas: 6.5%
- Maryland: 6.2%
- Massachusetts: 5%
- Connecticut: 3.8%
- Louisiana: 3.4%
- New Jersey: 3.2%
- Idaho: 2.6%
- California: 2.1%
- Pennsylvania: 1.3%
- Rhode Island: 0.9%
- Vermont: -0.8%
- Colorado: -0.9%
- Illinois: -0.9%
- Virginia: -2.1%
- Kansas: -2.4%
- Nevada: -2.5%
- Arkansas: -2.6%
- North Dakota: -3.2%
- New York: -3.3%
- Florida: -3.4%
- Montana: -3.4%
- Alabama: -3.5%
- Hawaii: -3.6%
- Nebraska: -4%
- Minnesota: -4.2%
- Michigan: -4.8%
- Washington: -4.9%
- New Hampshire: -5.3%
- Wisconsin: -5.6%
- South Dakota: -5.8%
- Kentucky: -6.1%
- South Carolina: -6.6%
- Utah: -6.9%
- Mississippi: -7%
- Maine: -7.7%
- Alaska: -8.3%
- Iowa: -8.4%
- Wyoming: -8.5%
- Missouri: -11.3%
- Tennessee: -11.3%
- Georgia: -12.8%
- Arizona: -13.8%
- Oregon: -14.1%
- Oklahoma: -14.4%
- Delaware: -14.7%
- Indiana: -14.7%
- West Virginia: -15%
- Ohio: -18.6%
- North Carolina: -21.1%
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
