Maryland Health Connection is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly basis, so let's take a look...

Maryland is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.4%).

Unlike the other five states I've written updates about so far, however, Maryland is unique in that it's the first state I've seen in which the year over year increase has grown a bit over time...at least as of March, anyway. Effectuated enrollment was 12.6% higher in January, 4% higher in February and 2.3% higher in March, for a Q1 average effectuated enrollment 6.1% higher than Q1 of 2025:

As of June 2025, around 70,000 Nebraska residents were enrolled in Medicaid via the ACA's expansion of the program.

Last summer, after Congressional Republicans passed their Big Ugly Bill, I warned people against assuming that the gutting of Medicaid wouldn't hit until after the 2026 midterms:

Over at The New Republic, Greg Sargent has taken this thinking one step further, noting that by delaying so much of the ugliness of the new law until 2027 or beyond...

Republicans know how unpopular all this will be. So they’ve structured the bill so the tax cuts land immediately, while many of the Medicaid cuts get going in 2027 and 2028. That’s meant to spare them in the midterms.

via Wikipedia:

Medicare Advantage (technically "Medicare Part C" & originally called "Medicare+Choice") is a type of health plan in the United States offered by private companies as part of the original Social Security Act of 1965 that created Medicare. It permits a private insurance option that wraps around traditional Medicare. Medicare Advantage plans attempt to fill some coverage gaps and offer alternative coverage options.

Under Part C, Medicare pays a plan operator a fixed payment for each enrollee. The operator then pays for their medical expenses. Traditional Medicare directly compensates providers on a fee-for-service basis. Plans are offered by integrated health delivery systems, labor unions, non profit charities, and health insurance companies, which may limit enrollment to specific groups of people (such as union members).

The Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

January 2026 Key Findings

Medicaid and CHIP Enrollment

• In January 2026, 75.3 million individuals were enrolled in Medicaid and CHIP.
• 68.0 million individuals were enrolled in Medicaid, and 7.2 million individuals were enrolled in CHIP.
• 39.4 million adults were enrolled in Medicaid, and there were 35.9 million Medicaid child and CHIP enrollees.

Total Medicaid/CHIP enrollment in December 2025 dropped about 1.3% from December 2025, or by around 943,000 people.

Welp. Via Ariel Hart at The Current GA:

More than half a million Georgians have dropped health insurance coverage amid stiff premium price hikes for federally subsidized Affordable Care Act plans, according to data obtained by The Current GA and Georgia Recorder.

The 37% enrollment drop — from 1.5 million Georgians in January 2025 to 950,000 as of April 17, 2026 — dwarfs any previous decline in the state since the launch of so-called Obamacare health insurance plans in 2014.

From the New Jersey Dept. of Banking & Insurance:

Cost Increases from Washington’s Inaction Drives nearly 70,000 New Jerseyans to Drop Health Coverage since January

Expiration of Federal Subsidies Increase Health Care Costs for Working and Middle-Class New Jerseyans

Residents Urged to Stay Covered to Protect Their Health and Avoid Higher Out-of-Pocket Health Care Costs

TRENTON — -- Inaction by the Trump Administration and Congress to extend federal enhanced premium tax credits for consumers purchasing coverage through health insurance marketplaces under the Affordable Care Act has resulted in nearly 14% of those initially enrolled in health plans through Get Covered New Jersey to drop their coverage. As of April 15, 2026, total enrollment on the State Exchange stood at 440,362 – reflecting a net loss of 68,830 enrollees since the end of Open Enrollment.

The Massachusetts Health Connector is one of the handful of states operating their own ACA exchanges which publishes effectuated enrollment data on a monthly (actually weekly) basis, so let's take a look...

Officially, Massachusetts is one of the ten states in which Qualified Health Plan (QHP) selections during Open Enrollment actually increased year over year (by 3.7%).

However, as I expected and have warned about repeatedly, the year over year change in effectuated enrollment is a different story: While effectuated enrollment in January was actually 8.5% higher than January 2025, it has since dropped off rapidly and April 2026 enrollment is actually 4.3% lower than it was a year earlier...that's a swing of 14,000 more plan selections to over 15,000 fewer people actually enrolled.

Overall, average monthly effectuated enrollment is still up slightly for the first four months, but only by around 1,600 people.

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:

Note: This is an updated & expanded version of a post I wrote last October.

A couple of weeks ago, I received an email from a journalist who included this eyebrow-raising comment:

When I interviewed our Congressman, he said the ACA was a massive giveaway to insurers -- that premiums have increased 26% per year on average. That doesn't seem to match what little data I can scrape up, so I wanted to ask you: Since implementation in 2010, how much have premiums risen annually overall? Do you have data on how much or little they've risen or fallen for each year?

To this reporter's credit, he was skeptical about such a claim and reached out to me.

Me, December 26th:

...I'm bringing all of this back up again today because I strongly suspect that the situation is about to reverse itself, with the Trump Administration already preparing to brag about impressive-sounding ACA enrollment numbers for 2026 in spite of the enhanced tax credits expiring less than 60 hours from now...even though the actual negative impact of the expiring tax credits (along with several other administrative policy changes made by CMS this year) likely won't be known for several months after Open Enrollment officially ends in January.