Over 63,000 Utahns have ditched their health insurance since federal subsidies for the Affordable Care Act expired in January.
Federal data released in June, and first reported by the Associated Press, offered insight into how states have been impacted since those subsidies expired.
Utah's dip accounts for 15.8% of the state's 400,330 federal marketplace enrollees in 2025, and it's middle of the pack compared to other states. Illinois only saw a 0.4% decrease, but states like Ohio and Oklahoma each saw nearly one-third of their ACA enrollment disappear. The data released by the federal government only looked at enrollment change from February 2025 to February 2026.
But even though Utah's drop was not the steepest in the country, Rachel Craig, government affairs manager for the Association for Utah Community Health, said there's still cause for concern.
"Especially because we don't know exactly if that's going to be it," she said. "Because there's still an opportunity basically until [we see April's data] for more people to drop off."
April, said Craig, is when "effectuated enrollment" is determined. That measures the people who have paid premiums or other costs for their health insurance plan to go into effect. She said that data might not get released until the end of this year.
"I would guess we'll probably hit around a 20% decrease in marketplace enrollment overall year over year, maybe 25%, but that might be a little bit high," she said.
People on the ground helping Utahns sign up for coverage said they encountered a great deal of uncertainty — and sticker shock — when the subsidies expired.
"What we found is that many people were completing the application process for renewals only to find that the cost of their program had become prohibitively expensive," said Take Care Utah director Daryl Herrschaft. "Another group of folks were a bit delayed in realizing the cost had gone up because of auto renewals."
Herrschaft's organization focuses on helping Utahns access health insurance, and he said he's also noticed an overall decline in inquiries about the marketplace process, something he said could indicate that some of his clients have stopped trying.
Health insurance costs increased by an average of 22% for millions of Americans on marketplace plans when Congress did not extend subsidies for the Affordable Care Act last year.
Utah Health Policy Project Executive Director Matt Slonaker said those jumps in cost haven't just led to more people choosing to go uninsured. There's also been an increase in those who might be underinsured.
"There were folks really finding great opportunities on the marketplace before the enhancements expired," he said. "They were going from silver to gold [plans] and getting great coverage and lots of options and choices. And now they're going from silver to bronze, bronze high deductible or no coverage."
Slonaker said being underinsured can be just as risky as no coverage at all, especially if a plan does not adequately offset the cost of care. Increased costs are also something Craig thinks could lead to a compounding effect in the future as people struggle to justify paying for a health insurance plan they might not see value in.
"Next year maybe they've decided. 'I don't need this. I'm healthy. I'm fine,'" she said. "And, you know, that's all fine and good until you get into a car accident, or until you have a mental health crisis, or you get diagnosed with a medical condition."
There is a lack of optimism from people in the industry that enrollment could bounce back. Slonaker said it took years of effort to get 400,000 Utahns signed up for health coverage through the federal marketplace, which made Utah the fourth highest state per capita for ACA enrollees. But he thinks it could take "more time probably to regain and go back to where we were than it took to lose these numbers."
Craig said she's not holding her breath for any legislative relief in the coming year. Neither is Slonaker. He said he's not too optimistic the subsidies could return in the future, even if health care costs take center stage for some campaigns in the upcoming midterm elections.
"That would help. That would be great. But would it change things overnight? Unfortunately, no," he said. "It takes a while for the psychological aircraft carrier to change direction."
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