New York, like 8 of the other 9 states I've run 2026 effectuated enrollment analysis of so far, once again has unique circumstances which make it an outlier compared to most states when it comes to analyzing ACA exchange enrollment and comprehensiveness of coverage.
This is no coincidence for a simple reason: The only ACA exchanges which provide monthly effectuated enrollment data at all are the 21 which are hosted on a state-based exchange platform...which also tend to be states which offer their own supplemental financial assistance or other special healthcare coverage programs specifically targeted towards the ACA individual market (as an aside, 16 of those 21 states are Democratic-leaning, with the remaining 5 considered either swing states (Georgia, Nevada, Pennsylvania) or red states (Idaho, Kentucky).
The biggest distinction here is that, like DC, Minnesota and Oregon, New York has had a Basic Health Plan (BHP) program in place for the past decade. As my colleague Louise Norris explains:
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment") as well as how comprehensive the policy is (ie, its "Actuarial Value").
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.
Once again: The true measure of ACA healthcare coverage enrollment isn't how many people select policies during the Open Enrollment Period, it's how many actually have those policies in effect (aka "effectuated enrollment").
Unprecedented number of Washingtonians drop health insurance following Congress’ failure to renew enhanced premium tax credits
New report shows expiration of enhanced premium tax credits resulted in nearly 13 percent decrease in qualified health plan enrollees compared to last year
Just 5 days ago I posted a look at how effectuated ACA healthcare coverage enrollment was going in Maryland for the first quarter of 2026. Since Maryland Health Connection is one of the few states which publishes effectuated enrollment data on a monthly basis, I was able to look at hard enrollment data (along with demographic breakouts) through March.
As I noted last week, 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%).
I also noted that as of March, 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, with effectuated enrollment being 12.6% higher than it was a year earlier 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.
