ACA coverage drops on both sides of the state line
Add Axios as your preferred source to
see more of our stories on Google.
Illustration: Annelise Capossela/Axios
A new Axios-Ipsos poll finds two-thirds of Americans want the federal government to spend more to lower health costs, and if you buy your own insurance in Kansas or Missouri, you've likely felt why.
Why it matters: Kansas and Missouri lost more than 120,000 Affordable Care Act enrollees this year as premiums soared. Two weeks before the midterms, Americans say they'd back candidates who would lower costs.
Catch up quick: The ACA marketplace, often called Obamacare, is where people get coverage when they don't have it through work or a program like Medicare.
- Extra tax credits added in 2021 lowered monthly ACA premiums, and enrollment roughly doubled in Missouri and more than doubled in Kansas by 2025, Commonwealth Fund figures show.
- Those credits expired at the end of 2025.
State of play: As of February, paid marketplace enrollment was down around 25% in Missouri and just over 20% in Kansas from a year earlier, steeper than the national decline of around 12%.
- The federal data, released over the summer, counts people who signed up and actually paid for their 2026 coverage.
- People who lost the credits were told to expect premiums to more than double on average.
- Many remaining enrollees switched to plans with lower monthly costs but higher deductibles, a Missouri marketplace navigator said.
The other side: The Trump administration says much of the national drop comes from cracking down on improper enrollment, like people signed up by brokers without their knowledge.
- Last month, the federal agency that runs the marketplace canceled coverage for more than 760,000 people nationwide it deemed unauthorized.
Zoom out: Similar to the heartland, many Americans nationally want to go even further. More now back "Medicare for All" than oppose it, the Axios-Ipsos American Health Index found.
- 43% support a government-run plan that would cover everyone and largely replace private insurance, while 24% oppose it and 32% aren't sure.
- Ipsos surveyed around 1,100 U.S. adults Sept. 25 to 28, with a margin of error of plus or minus 3 points.
What we're watching: Candidates who back broader government aid for health costs or prescription drug discount programs could also gain an edge, the poll suggests.
What's next: If you're on a marketplace plan, shopping for 2027 coverage opens Nov. 1 on HealthCare.gov. Sign up by Dec. 15 for coverage that starts Jan. 1. Insurers are seeking higher premiums again.