Enrollment in Affordable Care Act marketplace plans in Missouri fell by nearly 10% this year, according to new data released after the close of the 2025–26 sign-up period in January.
About 365,000 Missourians enrolled in coverage — roughly 42,000 fewer than last year.
Health policy experts point to the expiration of enhanced federal tax credits as a key reason for the decline. The subsidies had helped keep premiums low, and without them, many consumers are now facing significantly higher costs for similar coverage.
Rachel Swindle, a Harvard University PhD candidate who studies marketplace insurance, says the drop in enrollment could have broader consequences.
"As those younger, healthier people exit the marketplace because their premiums are going up, the risk pool gets sicker and more expensive to cover from the insurance company's perspective," Swindle said. "It's going to almost certainly get worse. It's just how much worse it is going to get."
Swindle says the current enrollment numbers may still fall in the coming weeks. Many enrollees were automatically re-enrolled and remain in a grace period to pay their premiums. Those who fail to make payments could lose coverage, further reducing the total.
"So basically when you enroll in coverage, there's a grace period for non-payment of premiums," she said. "The numbers that we have now include people who will likely be kicked off of their insurance plan when they fail to make that premium payment during the grace period."
Swindle recently co-authored a study examining states that have released enrollment data after the grace period. In each case, total enrollment declined.
She says rising costs may push more people to seek alternative coverage — or go without insurance altogether — raising concerns about the stability of the marketplace in Missouri.
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