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Florida lost 450,000 ACA enrollees as Trump officials and analysts clash over why
ReFlorida lost 450,000 ACA enrollees as Trump officials and analysts clash over why
Florida lost more ACA enrollees than any other state after federal subsidies lapsed, with 450,000 people dropping coverage. The decline comes as Trump administration officials attribute the losses to fraud and improper enrollments, while policy analysts point to rising premiums and partisan disputes over government reporting.
Florida lost more Affordable Care Act enrollees than any other state after Congress allowed pandemic-era subsidy increases to lapse, with 450,000 residents dropping coverage in early 2026. The state's effectuated enrollment fell 10%, from 4.3 million to 3.85 million, according to data from the health policy research group KFF.
The decline follows a December 2025 decision by Congress not to extend the enhanced premium subsidies that were put in place during the COVID-19 pandemic. That decision came after heated partisan debate and the longest federal government shutdown in U.S. history. The rollback increased premiums for ACA buyers by an average of 37%, or about $1,000 per year, nationally.
Florida is uniquely dependent on the ACA. At 40%, the state has the smallest proportion of its workforce receiving health insurance through an employer in the nation. More than 20% of Floridians under age 65 use the ACA, compared with 7% nationally. Florida also has one of the highest rates of uninsured individuals under 65 and the highest number and proportion of users of ACA subsidies.
The national picture shows 19.1 million Americans had effectuated ACA enrollment in 2026, a 12.4% drop from 2025. That decline was not distributed evenly across states. Ohio and Oklahoma tied for the largest proportional drop at 32%. Among the seven states with the highest ACA proportional enrollments, South Carolina lost 29%, Mississippi 26%, and Alabama 23%. Utah saw a 16% decrease. Texas recorded a 4% decline and Georgia 8%. Only New Mexico saw an increase, at 14%, while Illinois was unchanged.
The Trump administration and policy analysts are clashing over the causes. A June 2026 report from the U.S. Department of Health and Human Services stated that almost 3 million people who received a subsidy in 2025 lost coverage in 2026. The report suggested the subsidies were not appropriate because many recipients were high-income individuals, and it claimed others were eligible for other public insurance programs such as Medicaid. Administration officials have also contended that improper enrollments were the result of widespread fraud.
Many healthcare policy analysts disagree with the fraud contentions, noting that partisan politics have become part of the dissemination of government reports. The analysts point to the premium increases as the primary driver of enrollment losses.
Under the original ACA legislation signed into law in 2010, everyone whose premium was subsidized was required to contribute to their plan. People earning 115% of the poverty level contributed 2.1% of the plan's cost, and those earning 400% of the poverty level contributed 10%. In 2021, Congress passed legislation eliminating premiums for people with the lowest incomes and reduced costs for higher-income people. For the first time, the 10% of enrollees making more than 400% of the poverty level became eligible for a subsidy. Following those changes, effectuated enrollment increased from 13.5 million in 2022 to 21.8 million in 2025.
For Florida, it is not yet clear what the decline of 450,000 enrollees will mean for the overall state uninsured rate. Some may transfer to a spouse's policy, while others may find a lower-cost catastrophic insurance policy. The complete picture will not emerge until 2027, when state uninsured rates are released.
The 2025-26 enrollment changes showed that 2.7 million Americans left the ACA exchange, and 1 in 10 of them reported becoming uninsured. Prior to the subsidy rollbacks, analysts predicted about 6 million people would leave the exchange, with an estimated 80% of them becoming uninsured. So far, the outcome has not been as bad as feared, possibly because consumers opted for less coverage rather than dropping it altogether. The 2026 data shows a large drop in the proportion of individuals purchasing the middle-level silver plans.
