Arizona has seen one of the sharpest drops in Affordable Care Act marketplace health insurance enrollment since Congress let subsidies expire for those plans at the end of last year, according to a new analysis from the health policy research organization KFF.
KFF reports about 357,000 Arizonans signed up for health coverage this year through the ACA marketplace — a 16% drop from the record 423,000 Arizonans who chose ACA health plans last year. Only three other states saw larger rates of decline in enrollment.
States with their own subsidy programs or more robust health care outreach efforts have so far retained more ACA enrollees, KFF reports.
Most Arizonans using marketplace plans had been receiving enhanced premium tax credits, which significantly lowered costs. The credits expired at the end of 2025, after Congress did not reach a deal to extend them. The partisan fight over whether to extend the tax credits led to the longest full federal government shutdown in U.S. history from October through mid-November of 2025.
The tax credits were introduced in 2021 as part of the pandemic relief package, the American Rescue Plan Act. And the cost savings created by the credits contributed to a surge in enrollment in ACA marketplace plans in the years since.
Arizona's ACA enrollment increased 177% from 2020 to 2025, according to KFF.
Now that the credits have expired, monthly premium costs for enrollees have increased 58% on average, according to KFF’s analysis, and many enrollees are opting for plans that cover less. On average, enrollees’ deductibles have risen by more than $1,000.
KFF projects ACA enrollment could decline even further as the year goes on and people find they can’t afford the higher costs for their plans.
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