Arizona’s ACA Enrollment Drop Is a Warning Sign for Health Care Access

A new analysis from the Center on Budget and Policy Priorities (CBPP) shows that Affordable Care Act Marketplace enrollment fell in nearly every state after enhanced premium tax credits expired — and Arizona was among the hardest hit.

According to CBPP’s review of Centers for Medicare & Medicaid Services data, Arizona’s effectuated ACA Marketplace enrollment dropped from 363,110 people in February 2025 to 255,927 in February 2026. That is a loss of 107,183 Arizonans, or 30% of the state’s Marketplace enrollment. Nationally, enrollment fell by 12%, meaning Arizona’s decline was more than twice the national rate.

Arizona did not have the single largest percentage decrease — Ohio and Oklahoma each dropped by 32% — but Arizona’s 30% decline was one of the steepest in the country. For a state where many families already struggle with housing, food, transportation and medical costs, this is alarming.

The reason matters. Enhanced premium tax credits made ACA coverage more affordable for millions of people. When those enhancements expired, monthly premiums rose for many households. For many Arizona families, that kind of increase is not a manageable inconvenience; it is the difference between being insured and going without care.

It is important to distinguish this Marketplace enrollment crisis from AHCCCS, Arizona’s Medicaid program. Arizona’s FY2027 budget did include funding to help AHCCCS prepare for federal H.R. 1 changes — including staffing and systems work to manage new eligibility and documentation requirements. That administrative support matters, especially as AHCCCS and the Department of Economic Security prepare for more complex federal rules.

But that funding does not create a state supplement to replace lost ACA Marketplace premium tax credits, nor does it directly offset higher premiums for Arizonans who buy insurance through the Marketplace. In other words, the state budget may help AHCCCS administer federal changes, but it does not solve the affordability problem facing Marketplace enrollees who lost enhanced premium assistance.

That distinction matters for families who fall between systems: workers whose jobs do not offer affordable insurance, small business owners, early retirees, students, caregivers, part-time workers and households whose incomes fluctuate. They may not qualify for AHCCCS, but they also may not be able to afford Marketplace coverage when premiums rise. These are our neighbors. They sit in our pews, serve in our ministries, care for children and elders, and keep Arizona communities running.

Arizona’s drop should concern people of faith because health coverage is not just a financial product. It is access to cancer screenings, prescriptions, prenatal care, behavioral health services, chronic disease management, emergency care and peace of mind. When people lose coverage, they often delay care until illness becomes more serious and more expensive. Congregations, social ministries, hospitals, clinics and families all feel the consequences.

The ELCA social statement Caring for Health: Our Shared Endeavor reminds us that health care is a shared responsibility and that caring for the health of others is part of love for neighbor and the pursuit of a just society. LAMA sees Arizona’s ACA enrollment decline as a moral warning: when coverage becomes unaffordable, vulnerable neighbors are pushed further from the care they need.

Policymakers should take this decline seriously. Congress can restore and strengthen premium tax credits so families do not lose coverage because premiums rise beyond reach. Arizona leaders can also examine whether state-level strategies could help stabilize coverage, support outreach and enrollment assistance, and reduce barriers for families trying to stay insured.

For LAMA, the bottom line is simple: access to health care helps neighbors live with dignity, stability and hope. Arizona’s sharp Marketplace enrollment decline is not just a statistic. It is a call to renewed advocacy for affordable health coverage and a reminder that public policy choices shape whether our neighbors can get the care they need.