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This analysis estimates that 1.4 million uninsured individuals in the ten states without Medicaid expansion, including many working adults, people of color, and those with disabilities, remain in the “coverage gap,” ineligible for Medicaid or for tax credits that would make coverage affordable through the Affordable Care Act’s Marketplaces.
Following several years of rapid enrollment growth in the Affordable Care Act (ACA) Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in ACA Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the expiring federal enhanced tax credits, generally saw lower drops in enrollment (an 6% decline versus 15% for the federal marketplace).
Health Policy 101 is a comprehensive guide covering fundamental aspects of U.S. health policy and programs, including Medicare, Medicaid, the Affordable Care Act, employer-sponsored insurance, racial and ethnic disparities, and more. The chapters can be downloaded in a PDF format for faculty and student use, and the information will be updated annually or as data and circumstances change.