ACA Enrollment Surges in Trump-Won States, Reaches 24.3 Million

Enrollment in the Affordable Care Act (ACA) marketplaces has surged, reaching a record 24.3 million in 2025, with significant growth concentrated in states won by President Trump in the 2024 election. According to a KFF analysis, enrollment in these states has increased by an average of 157% since 2020, compared to just 36% in those carried by former Vice President Harris. Key states like Texas and Mississippi saw enrollment growth of over 250%, while nearly all states experienced some increase. This surge is largely attributed to enhanced federal subsidies introduced in 2021, which are set to expire at the end of the year unless Congress acts. The impending expiration of these subsidies raises concerns about potential enrollment declines and the political implications for Republicans. Analysts have noted that the continuation of these financial aids is critical to maintaining coverage among low- and middle-income enrollees.