Minnesota: February MNsure report provides more warning signs re both effectuations & coverage levels

A few weeks ago I noted that the first hard data on effectuated ACA marketplace enrollment (as opposed to how many people selected plans) had started to come in from a handful of states...Maryland and Massachusetts in particular. While the data is still sparse, the early trendlines are already starting to show up:

• Maryland: Effectuated enrollment dropped 4.2% from January to February, a rate 75% higher than the Jan - Feb drop last year, and nearly 4x higher than it was from Jan - Feb 2024.

• Massachusetts: From January - February 2026 effectuated enrollments dropped 3.7%, compared to a 4.1% increase month over month in 2025.

These bullets take on more significance when you consider that both Maryland and Massachusetts provide their own state-based supplemental financial assistance to ACA enrollees, and in fact both states beefed up funding of these programs for 2026 to help mitigate the damage caused by the enhanced federal tax credits expiring as well as other changes to the ACA made by the Trump Regime.

This morning, Minnesota became the third state to publish detailed February enrollment data which, again, allows me to compare January to February changes:

The first thing to notice is that while total Open Enrollment Period plan selections dropped by 8.1% from 2025 to 2026, effectuated enrollment as of February has dropped even more, by 8.6%. This is also reflected in the January - February effectuated change, which has increased each year since 2022, but only increased about half as much in 2026 (+3.8%) vs. 2025 (+7.3%).

As noted in the March Board of Directors dashboard:

• ...MNsure effectuated enrollment typically peaks in February of each year.

• In 2024, the peak was in June due to the end of the pandemic era Medicaid continuous coverage policy.

• MNsure is assuming our peak in 2026 was in February as in typical years.

• Peak effectuated enrollments dropped by nearly 11,000 between 2025 and 2026 due to federal policy changes like the end of enhanced tax credits.

I actually have the Feb. 2025 - Feb. 2026 enrollment drop at 12,527, so I'm not entirely sure where the 11,000 figure comes from.

In terms of financial assistance, the percent of Minnesota ACA households who received federal tax credits dropped from 61% to 50%...a level not seen since 2021 (keep in mind that the enhanced tax credits were retroactively applied to the beginning of 2021, which may have skewed the data that year):

In addition to the effectuated enrollment drop, the other major danger this year is the coverage level shift as enrollees were forced to "buy down" to worse plans in order to help mitigate the dramatic premium hikes caused by the subsidies being made dramatically less generous:

Enrollment in Bronze plans (which have much higher deductibles & co-pays) increased from 50% in 2025 (if you include Catastrophic plans, which aren't being offered in MN this year) to 56%, while enrollment in Silver & Gold plans dropped from a combined 50% to 44%.

I should also note that the BoD report also includes some additional warning signs for the future caused by the GOP's Big Ugly Bill (although bullets 2 & 5 have already gone into effect):

Reminder: HR1 Likely to Decrease Enrollment

• Shortened open enrollment
• Sunset of enhanced premium tax credits
• Prohibition of auto-renewals
• Manual verification of income and citizenship data
• Excludes most lawfully present enrollees from accessing premium tax credits