Recent data shows that in 2026, the Affordable Care Act (ACA) coverage effectuation rate fell in all states except for New Mexico. Nine states saw a decline of 25% or more and the effectuation rate fell under 90% nationwide for the first time since 2019. The Centers for Medicare and Medicaid Services data shows that 19.2 million people had effectuated ACA marketplace coverage in February 2026 after choosing a plan in January 2026, compared with 21.8 million the previous year, which was a decline of about 12%.
What Caused the Decline?
A major factor behind the decline was the expiration of enhanced federal premium tax credits at the end of 2025. This change increased the amount many consumers have to pay for marketplace coverage. Average monthly premium payments after tax credits saw a 58% increase in 2026, from approximately $113 to $178. Higher costs may have made it more difficult for some households to maintain coverage after initially selecting a plan.
Effectuation Rates Across the States
The national effectuation rate for ACA plans is now 83%, meaning 17% of individuals or families who selected a plan in January 2026 did not maintain it past the first month. Almost every state saw a significant decline in effectuation rates. Mississippi saw the most drastic drop, with just a 61% effectuation rate. South Carolina, Indiana, Louisiana, and Oklahoma experienced similar declines, with each state’s rate of effectuation falling below 70%, while the effectuation rates of Vermont, California, New Mexico, Idaho, and Nevada, all remained steady at roughly 90-95%.
Another Premium Spike is Coming
As Americans get ready for another round of ACA Marketplace shopping in October and November, the predictions are concerning. In Arizona, those shopping the marketplace are bracing for spikes of 3-34% in coverage costs.
In an interview with Arizona’s Family, Adena Hope Bank, a self-employed clinical worker and Arizona citizen, expressed her frustration with rising costs in the ACA marketplace. “I’m furious and I’m terrified because already I am staying away from doctors as much as I can,” she shared. Because of her chronic fatigue syndrome, Bank relies on ACA for comprehensive coverage. But with her premium monthly cost reaching $1,100, she expressed her concern that she will soon have to look elsewhere for healthcare coverage.
With costs continuing to rise, experts estimate that the 2026 ACA enrollment numbers could see a further decline of between 17 and 26% in the next year.
Solidarity HealthShare is a Better Option
At Solidarity HealthShare, we believe that families should not have to choose between having coverage for their loved ones and putting food on the table. That is why we are committed to providing healthcare alternatives from conception to end of life. Our Members know that we will advocate for their needs, expanding access to affordable, transparent care. Quality healthcare should never come with a cost barrier.
For more information about joining the Solidarity community, please contact our Member Care team today at 737-SHARING or check prices online.