All U.S. states except one in the Mountain West are seeing a decline in the number of people paying for Affordable Care Act coverage. Nationwide, five million fewer people are enrolled than last year, federal data shows.
The decline comes after President Donald Trump and Congress let Covid-era Affordable Care Act subsidies expire in January, resulting in skyrocketing monthly premiums, mostly among people making over 400% of the federal poverty level, or about $62,000 per year.
The Trump administration has said enrollment is dipping, in part, because it’s reducing “improper, phantom and fraudulent” sign-ups. State healthcare experts, however, say a lot of the reductions still have to do with affordability.
Two states in the Mountain West saw vastly different outcomes. The first, New Mexico, is an outlier: It’s the only state nationwide where enrollment numbers have increased.
The second, Wyoming, illustrates the broader trend of enrollment dipping across the country and how people are deciding to go uninsured rather than pay high premiums.
New Mexico: The Outlier
After the subsidies expired in January, New Mexico has quietly positioned itself as the only state in the country to fully shield ACA enrollees from steep premium increases.
Enrollment in the state rose by 14.5% from February 2025 to February 2026, or about 10,000 people, according to the most recent federal data.
DeAnna Stock is the director of coverage, affordability and expansion with New Mexico’s Healthcare Affordability Bureau. She said the state’s decision to run its own exchange and create a dedicated affordability fund has kept coverage stable while other states saw dramatic increases.
New Mexico operates a state-based exchange, similar to those of Colorado, Idaho and Nevada, and separate from the federal marketplace, healthcare.gov. That autonomy, Stock said, allowed lawmakers and the governor to move early when they saw signs that federal support might waver.
In 2021, New Mexico’s state legislature and Gov. Michelle Lujan Grisham established the Healthcare Affordability Fund, financed through an assessment on health insurance carriers. The goal was to keep premiums and out-of-pocket costs low so more residents could afford coverage.
When federal enhanced subsidies ended, some consumers in states using the federal exchange saw their monthly premiums soar. New Mexico was not immune to underlying cost pressures, Stock said, but the fund allowed the state to hold premiums roughly at prior-year levels and preserve zero- or low-cost plans with stable deductibles and copays.
The fund, backed by continued support from both the governor and the state legislature, is now authorized and funded through 2030.
“Once the focus is on supporting New Mexicans and keeping healthcare affordable,” Stock said, “collaboration across party lines becomes not just possible, but necessary and stands as an example of bipartisanship.”
In March, Gov. Lujan Grisham signed a bill, transferring $91 million into the fund by July 1, 2027, and then more than $162 million in the two fiscal years following. The fund currently has $200 million in it, according to a fiscal analysis.
Wyoming: The Norm
The story is quite different in Wyoming, as the state has not approved its own subsidies.
The Cowboy State is one of many seeing a steep drop-off in the number of people paying for healthcare through the public marketplace. Federal data shows a 22% decline from February 2025 to February 2026, amounting to about 9,800 people.
That’s the second-largest drop in the Mountain West, behind Arizona, and the 13th-largest dip nationwide. Utah, for example, saw the third-largest dip in the region, losing more than 63,000 enrollees after subsidies expired.
Rachel Bouzis, director of policy and learning at Wyoming’s Natrona Collective Health Trust, a private foundation, said she’s not surprised, since healthcare is already expensive in the rural state.
“There just aren't very many people spread across huge geography, and so it costs a lot to deliver all of that,” Bouzis said, although more densely populated states are also seeing big drops, like Arizona, which had a 30% decline in enrollment.
She said the monthly premium increase has resulted in healthcare being out of reach for daycare providers or people who work in restaurants, among others, citing some premiums going from $60 a month to $900. So, she said, many people are deciding to roll the dice and go uninsured.
About 34,500 people were enrolled in February, versus about 44,300 the previous year.
“A lot of people are looking at that going, ‘well, I'm just not going to have insurance,’” Bouzis said. “‘I can't do that financially. I'll just hope that something doesn't happen.’”
This means fewer people are getting preventative care, she said, which results in them being sicker in the long run.
“I'm better off putting what I pay for health insurance monthly into a savings account and pray nothing major happens,” one unnamed Sheridan County, Wyoming, woman said in a recent survey from the health trust.
She’s identified as a Republican between the ages of 35 and 44.
Overall, the survey found that 81% of Wyoming voters say the cost of healthcare is an extremely or very serious problem. Two in five Wyoming voters are concerned about losing their health insurance, the survey found.
One survey respondent, who identified as a man in his 50s living in Lincoln County, Wyoming, and a Trump voter, said ACA subsidies need to be reenacted: “My health care costs have quadrupled, and I am already living paycheck to paycheck.”
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
