Enhanced advance premium tax credits, first signed into law as part of the American Rescue Plan in 2021, increased the amount that enrollees in the Affordable Care Act (ACA) marketplaces receive in federal subsidies to pay for monthly health insurance premiums. These enhanced tax credits benefit low- and middle-income individuals who do not receive health insurance through an employer or other government program, including many small business owners and employees, farmers and ranchers, and people who are self-employed.
States won by Trump in 2024 have received more ACA premium tax credits, and had more enrollment growth, since the subsidies were expanded. This year, 18.7 million (77%) of the total 24.3 million ACA Marketplace enrollees live in states President Trump won in the 2024 election.
Since the enhanced premium tax credits were introduced, the number of people who receive health coverage through the ACA Marketplaces has more than doubled, and more than half (55%) of the national growth comes from Texas, Florida, Georgia, and North Carolina. In six states (Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia), enrollment has more than tripled in five years.
Nationwide, 93% of ACA Marketplace enrollees received premium tax credits in 2025, but enrollees living in states won by President Trump in 2024 were even more likely to have subsidized coverage. In Florida, West Virginia, and Alabama, 98% of people enrolled in Marketplace coverage received federal financial premium assistance, and 99% do in Mississippi.
Additionally, 80% of all premium tax credits ($115 billion) went to ACA Marketplace enrollees in Trump-won states.
