The Republican Plan to Take Away Your Health Care Is Working | The Waiting Room
Your 2026 ACA data update: 3 million Americans have lost health coverage.
Charles Gaba is a health care analyst who tracks policy and politics at ACASignups.net. Subscribe to his Substack!
Greetings, Lincoln Square readers!
The last edition included the second half of my deep, wonky dive into the final, official 2026 ACA Open Enrollment Period data, along with some initial effectuated data updates for California, Colorado, Georgia, Massachusetts, and New Jersey, plus a look at how employer-sponsored insurance premiums have compared to individual market premiums over the years.
Warning: Aside from the New Mexico story leading it off, this weeks edition is pretty depressing stuff.
First up, I have early 2026 effectuated enrollment data for another five states:
New Mexico: A rare bright spot in the Land of Enchantment
New Mexico is a massive positive outlier on both fronts in 2026, and it’s pretty obvious how they’re pulling it off: Not only is it the only state which is fully backfilling 100% of the enhanced federal tax credits which Congressional Republicans allowed to expire back in December for 100% of all enrollees, they doing this in addition to their existing state-based supplemental subsidy program.
While some other states are partially mitigating the damage, New Mexico is fully canceling out all of the lost subsidies as well as providing their own additional assistance this year.
2026 Open Enrollment Period (OEP) enrollment increased by a whopping 18% over OEP 2025 in New Mexico, and actual effectuated enrollment has continued to be well above the same month last year ... although that year over year increase has been gradually dropping and is only 5.6% higher this month than it was last May. Still, average monthly effectuated enrollment is 10% higher than it was a year ago.
Maryland: Hoo boy. I should’ve waited a few more days...
When I originally posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026, things looked similarly positive.
A major reason is that, like New Mexico, Maryland is fully backfilling 100% of the expired federal tax credits for all enrollees earning 100 - 200% FPL (which make up over 50% of total enrollees). Unlike New Mexico, however, it drops off quickly over that threshold: They’re covering 50% of the expired credits for enrollees who earn 200 - 400% FPL (another 33% of all enrollees).
Well, it looks like I jumped the gun a bit and even briefly forgot my own warning from months ago:
In fact, the actual enrollment drop won’t really be known until after April 1st, because the ACA requires insurance carriers to provide a 90-day grace period for non-payment of premiums...which means anyone who fails to make their January payment may not officially drop off the “effectuated enrollee” list until April ... and if the July reports don’t include April effectuations, it won’t show up then either.
Sure enough, a week later the Maryland Health Connection posted their April data, which showed enrollment dropping more than 6% from a year earlier.
Washington: Effectuated ACA enrollment down 11-16% so far; over 46,000 have already lost coverage
While the press release from the Washington Healthplan Finder lists enrollment as being down ~13% vs. last year so far, for February specifically it’s actually 15.7% lower than it was as of February 2025 (although the average for January & February combined seems to be more like 11.2%, though I had to make an educated guess as to what January effectuated enrollment was).
Again, it’s really the April effectuated data which will be more critical due to that 90-day grace period I mentioned above.
Pennsylvania: Effectuated enrollment drop not as bad as Pennie suggests but the trend line isn’t pretty...
Pennie, Pennsylvania’s ACA exchange, make things sound pretty dire on their website:
Since the close of OE 2026, January 31, 2026, an additional 60,000 consumers have dropped coverage through Pennie.
In total, including Open Enrollment 2026, Pennie has seen over 145,000 individuals cancel coverage.
As ugly as this figure is, it’s a little bit misleading, in that it includes those who terminated coverage but not those who newly enrolled in coverage; my standard measurement is the total number of effectuated enrollees each month (which includes both subtractions and additions).
On that front, the situation isn’t nearly as bad..but it’s still not looking good.
Official plan selections during the 2026 Open Enrollment Period (OEP) were actually slightly higher than they were during 2025 OEP. Since then, however, effectuated enrollment in Pennsylvania has indeed dropped off steadily...it was 1.2% lower in March, 3% lower in April and is 5.2% lower as of May than it was during the same months a year ago.
New York: Effectuated enrollment down ~7% so far this year; will likely skyrocket this summer, but don’t get too happy...
🚨 If you’re one of the ~1.7 million New Yorkers currently enrolled in the state’s Essential Plan program, I strongly urge you to read my full post about the major changes to that program starting July 1.
The short version is this:
Currently, New Yorkers who earn more than 138% of the Federal Poverty Level (FPL) but less than 250% FPL (around $39K/yr for one person or ~$80K/yr for a family of four) are eligible for this special healthcare coverage program, which costs enrollees nothing in premiums, has no deductible and has very low co-pays or other out of pocket expenses.
Starting July 1st, however, due to the so-called “Big Ugly Bill” passed by Congressional Republicans and signed into law by Donald Trump last year, the household income eligibility threshold is being cut back from 250% to 200% FPL (around $32,000/individual or $64,000/family of four).
This means that roughly 450,000 Essential Plan enrollees will no longer be eligible for the program after June 30.
From the official fact sheet posted by NY State of Health:
Who is affected?
Enrollees with incomes between 200% and 250% of the Federal Poverty Level (FPL), ($31,920 - $39,900 annual income) will no longer be eligible for the Essential Plan starting July 1, 2026.
This impacts 450,000 individuals.
There are no changes for the 1.3 million enrollees with income below 200% FPL (income below $31,920)
What is changing and when?
Federal funding cuts mean New York State can no longer offer expanded Essential Plan eligibility after June 30, 2026.
Enrollees whose eligibility is ending received a notice from NY State of Health on April 1, 2026.
We will send another notice in early May with information about new coverage options.
What new coverage is available?
Most people affected by these changes can enroll in a Qualified Health Plan (QHP), with financial assistance.
QHPs have monthly premiums and other costs that differ from the Essential Plan. The average silver plan costs $220 per month after tax credits.
The enrollment window opens on May 16, 2026. Impacted enrollees will have until August 30, 2026, to enroll in new coverage without a gap in coverage.
What help is available to consumers?
Free in-person assistance from enrollment assistors
Customer Service Center: 1-855-355-5777
Web chat at nystateofhealth.ny.gov
Pregnant Individuals
All pregnant enrollees will stay continuously enrolled in coverage.
Pregnant enrollees whose due date is before January 1, 2027 will remain enrolled in the Essential Plan.
Pregnant enrollees whose due date is after January 1, 2027 will be transitioned to Medicaid on July 1, 2026.
Deferred Action for Childhood Arrivals (DACA)
DACA recipients with incomes at or below 138% FPL will move to Medicaid on July 1, 2026.
Higher-income DACA recipients who are pregnant will move to Medicaid on July 1, 2026.
Under federal rules, higher-income DACA recipients who are not pregnant will no longer qualify for any NY State of Health program after July 1, 2026.
In any event, that’s the state of play across 10 states for the first few months of 2026.
What about the rest of the nation?
Unfortunately, the Centers for Medicare & Medicaid Services (CMS) probably won’t be publishing effectuated enrollment data for every state until sometime in July, though it’s possible they’ll do so sooner. There was a scoop posted yesterday, however:
CMS admits over 3.0 MILLION have already lost ACA coverage so far this year
via Paige Cunningham of NOTUS:
More than one in five people who enrolled in health insurance through HealthCare.gov during open enrollment and in the weeks immediately following were dropped from coverage for failing to pay their first month’s premium, according to internal Centers for Medicare and Medicaid Services, or CMS, documents obtained by NOTUS that haven’t been made public.
The roughly 21% decline in enrollment in the 30 states using the federal marketplace is significantly higher than the rate of last year, when 12% of enrollees dropped off over the same time frame.
... This year also saw fewer sign-ups to begin with, leaving total ACA enrollment at around 19 million people, around 3 million fewer than one year ago, according to CMS documents.
... Nationally, ACA enrollment has declined somewhat less — around 17% percent — between February and April. That’s because the 20 states running their own marketplaces were able to retain far more customers, losing 8% since the beginning of the year, according to the CMS documents.
Cunningham’s story doesn’t include state-level details (nor does it provide effectuated numbers for January, February or March), but there’s still a lot to digest even in the top-line numbers.
The bottom line? Three million fewer people with effectuated ACA exchange coverage in April 2026 vs. a year earlier.
It also means that there’s a huge discrepancy between the 30 states hosted via HealthCare.Gov and the 21 which operate their own ACA exchanges.
Taking the 17% national & 21% FFM drops literally, that would mean nearly 2.5 million enrollees have lost coverage across HC.gov states (a 16.6% year over year drop), while just over 500,000 have lost coverage across the remaining 21 (a 7% year-over-year drop).
The state subsidies & other special programs put into place by many of the latter has been very effective at helping mitigate the coverage losses. By an amazing coincidence, 16 of those 21 states also happen to be controlled by Democrats, while most of the HC.gov states are GOP-controlled. As a result, those states are seeing coverage losses 2.4 times higher on a percentage basis and five times higher in raw numbers than the ones operating their own platforms.
Going forward, my guess is that the total number of people losing ACA coverage will likely be somewhere in the 4-6 million range, as projected by Wakely Consultants last month.
Meanwhile …
Cigna Sez Sayonara: Another major carrier bailing on ACA exchanges next year
The Cigna Group disclosed plans to exit the individual health insurance business under the Affordable Care Act, also known as Obamacare, leaving about 369,000 health plan members in 11 states looking for new coverage in 2027.
… Centene, a much bigger player in Obamacare, said such enrollment tumbled by 2 million enrollees to 3.58 million at the end of the first quarter compared to 5.54 million at the end of last year and 5.62 million in the year ago quarter. UnitedHealth Group’s UnitedHealthcare last week said its Obamacare enrollment was down as well, falling to 1.4 million from 1.7 million last year. And a year ago, CVS Health announced plans to exit the individual health insurance business, leaving about 1 million Aetna members in 17 states looking for new coverage for this year.
So that’s a 17% year over year drop for Cigna, a 36% year over year drop for Centene, and an 18% drop for UnitedHealthcare.
If you live in any of the following states and have coverage via Cigna, you’re gonna have to find a new carrier: AZ, CO, FL, GA, IL, IN, MS, NC, TN, TX or VA.
And finally, as Nebraska becomes the first state to actually start mandating “work reporting” for Medicaid expansion enrollees …
Oklahoma GOP moves to kill off Medicaid expansion entirely
In 2020, Oklahoma voters passed Medicaid expansion, adding more people to Soonercare. Republican lawmakers are advancing proposed constitutional changes to reverse that vote: House Bill 4440 and House Joint Resolution 1067.
If approved, both state questions would give lawmakers the ability to adjust or reverse Oklahoma’s expanded Medicaid eligibility without a majority vote of approval by Oklahomans, with one acting as a failsafe in case the other is unsuccessful during the Aug. 15 primary runoff.
... Both measures passed the Senate Rules Committee along party lines on Monday.
According to official data from the Centers for Medicare & Medicaid Services (CMS), Oklahoma had around 240,000 residents enrolled in Medicaid via ACA expansion as of last June, and as of March 2026 this had dropped slightly to 233,500 via the Oklahoma Health Care Authority.
If this goes through, those ~230,000 Oklahomans will lose healthcare coverage, with perhaps half of them instead becoming eligible for subsidized (but still vastly more expensive) ACA exchange coverage while the other half fall back into the Medicaid Gap, where they’re no longer eligible for Medicaid but also don’t qualify for ACA subsidies, putting any sort of decent coverage out of reach.
And with that, I’ll see you again in two weeks …
The Republican healthcare plan has not changed since Alan Grayson coined the phrase during the original ACA debate - "Don't get sick. If you do, die quickly."