(The Center Square) – Enrollment in the Affordable Care Act dropped 21.3% in North Carolina to 609,544 in the 12 months between February 2025 and 2026, according to federal data.
The percentage trailed 12 other states, each of which had fewer total enrollment decreases in total volume. Only two states had more in volume.
The data assessment is from the Trump administration and was posted in late June by the Centers for Medicare & Medicaid Services. More than 2.6 million Americans did not have the plans compared to the same time last year, with North Carolina’s drop from 774,226.
The 21.3% decline is 13th highest in the country by percentage. Others on the high end of decreases were Ohio (32.4%), Oklahoma (32.3%), Arizona (29.5%), South Carolina (29.1%), Minnesota (28.2%), Michigan (26.8%), Mississippi (26.4%), Louisiana (26.1%), Missouri (24.9%), Nebraska (22.8%), Alabama (22.5%) and Wyoming (22%).
The volume of 164,682 enrollment in North Carolina’s decline trailed Florida (442,785) and Texas (146,345). Florida’s more than 4.2 million enrolled in 2025 dropped 10.3%, and Texas’ more than 3.4 million enrolled a year ago dropped 4.3%. New Mexico (10,132) was the only state to gain enrollments and now eclipses 80,000.
The data set captured how many people signed up, how many were automatically reenrolled in 2026, and how many paid first monthly premiums to keep coverage.
Healthcare subsidies, often called enhanced premium tax credits, were the subject of a bitter fight in Congress in late 2025. Democrats wanted the renewal; few Republicans did. When they expired, some health insurance fees surged to double or triple previous amounts.
Another contributing factor is government oversight to eliminate fraud.
In the 2026 midterms, as always for federal or statewide elections, money in the pockets of voters is the No. 1 polling issue. Whether that’s labeled by pollsters as economy, consumer prices, inflation or otherwise, voters historically respond to poll sampling saying money in their pockets or accounts is top reason to choose candidates.
Election results, however, indicate mixed opinion on which candidates deliver.
