Which states have the highest share of ACA enrollees receiving premium tax credits?
Executive summary
Most ACA marketplace enrollees currently receive premium tax credits; national estimates say roughly 93% of enrollees get credits and enhanced credits are available through the 2025 coverage year [1] [2]. Available reporting and analyses show the biggest relative gains from the enhanced credits — and hence the highest shares of subsidized enrollees — tend to concentrate in states with large post-ARPA enrollment increases, particularly many Southern states that did not expand Medicaid, though no single comprehensive state-by-state ranked list of “highest share” appears in the documents provided [3] [4].
1. Where the subsidies are concentrated: large enrollment growth in some Southern states
Multiple analyses document that the expansion of enhanced premium tax credits (PTCs) since 2021 drove record marketplace enrollment and that much of that growth was concentrated in Southern states that did not expand Medicaid; reporters and analysts point to the South as a region where the enhanced credits brought in many new, subsidized enrollees [3] [4]. KFF and news outlets tie the surge in subsidized enrollment to the ARPA/IRA enhancements and show enrollment moved strongly into states with previously large uninsured populations [4] [3].
2. National headline numbers: almost all enrollees receive credits
Policy reporting from the Center on Budget and Policy Priorities (CBPP) states “nearly all enrollees (93 percent) receive PTCs,” with the average subsidy lowering premiums by about $536 per month; those figures frame why state shares matter: most marketplace enrollees nationwide now rely on subsidies [1]. KFF and other sources reiterate that enhanced PTCs drove marketplace growth to record levels — roughly 20–24 million enrollees in recent reporting — making the PTC the dominant financing mechanism for marketplace coverage [2] [4] [5].
3. Why Medicaid expansion status matters to state shares
Analysts explain a mechanism: in states that did not expand Medicaid, low-income adults who remain above Medicaid eligibility thresholds but below the subsidy thresholds can now qualify for very generous PTCs under the enhancements. That made coverage affordable for people just above the poverty line in non‑expansion states, increasing the share of subsidized enrollees in those states [3] [6]. Thus, state-level differences in Medicaid policy create predictable variation in how many marketplace enrollees receive credits [3] [6].
4. What the data sources do and do not provide
Public briefs and interactive tools (KFF’s calculator, CBO reports, CBPP briefs) offer state-level analysis of premium impacts and broad enrollment trends, but the set of documents supplied here does not include a definitive state-by-state ranked table listing “highest share of enrollees receiving PTCs.” KFF maps and state open-enrollment files underpin much of the reporting, but a precise ranking is not present in the material you supplied [2] [4] [7].
5. How expiration or policy change changes the picture
The enhanced PTCs are explicitly temporary in these sources — extended through 2025 — and expiration would change both the number and distribution of subsidized enrollees. KFF and others estimate large premium increases and enrollment losses if enhancements lapse, and they map uneven burdens across states with older populations or high subsidies — again showing variation by state but focused on premium impacts rather than a simple “share receiving credits” ranking [2] [7] [4].
6. Competing perspectives and implicit agendas in coverage
Advocacy and policy shops (CBPP, KFF, Bipartisan Policy Center) emphasize the protective effect of enhanced PTCs and warn of coverage loss if Congress does not act; industry and fiscal analysts (CBO, CRS summaries cited) focus on cost, integrity, and program mechanics [1] [8] [9]. Each source sets priorities: CBPP highlights access, KFF models household impacts, and CBO/CRS stress budgetary and rule-based implications. Those priorities shape which state-level details get emphasized [1] [8] [9].
7. What you can do next to get a definitive state ranking
To produce a precise ranked list of states by share of marketplace enrollees receiving PTCs, consult the 2025 Open Enrollment State-Level Public Use File from CMS or KFF’s state-level open-enrollment reports and maps — the sources cited here reference those underlying files but do not reproduce a full ranked table in the materials provided [4] [2]. Available sources do not mention a single compiled ranking in the documents you gave [4] [2].
Limitations: this analysis uses only the supplied documents; they document broad regional and state tendencies and give national percentages but do not contain a standalone, state-by-state ranked list of the “highest share” of ACA enrollees receiving PTCs [1] [2] [3].