Which states will lose the most ACA premium tax credit dollars when enhanced subsidies end in 2025?

1. What different analyses are actually claiming — the headline disagreements that matter

Multiple pieces of analysis make overlapping but not identical claims about who loses the most if enhanced premium tax credits end. One analysis lists eight states—Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas, and West Virginia—as facing more than a 50% drop in subsidized Marketplace enrollment and major affordability impacts, emphasizing enrollment loss and coverage declines ^[1]. Other work highlights Texas, Florida and Georgia as the largest dollar losers and ties those losses to projected uninsured increases and budget-law interactions, with KFF modeling cited for state-level uninsured changes ^[2]. A third set of analyses emphasizes economic ripple effects—dollar values of lost federal funding and downstream job and output losses—with a Becker’s summary ranking Texas ($6.3B), Florida ($4.2B), Georgia ($2.5B), Tennessee ($1.3B) and Louisiana (~$969M) as top monetary losers ^[3]. These claims align on a Southern and Sun Belt concentration but differ on exact rankings and whether the emphasis is enrollment, uninsured rates, or economic output ^{[5] [6]}.

2. Who emerges most consistently as the biggest losers — cross-study synthesis

When the studies are put side by side, Texas, Florida, and Georgia repeatedly appear among the states that will lose the largest amounts of premium tax credits or experience the largest coverage fallout if the enhanced subsidy policy expires. Texas is singled out across analyses for the largest federal-dollar loss and major enrollment impacts, while Florida and Georgia show up in KFF and Commonwealth Fund-aligned summaries as among the highest in potential uninsured increases and job impacts ^{[3] [2] [5]}. Several Deep South states—Mississippi, South Carolina, Tennessee, Louisiana, and West Virginia—also recur in enrollment-loss and uninsured-rise projections, indicating a geographic pattern tied to enrollment growth during the enhanced subsidy period and underlying coverage gaps ^{[1] [6]}.

3. How the studies measure impacts — dollars, enrollment, uninsured rates, jobs — and why that produces different lists

The differing rankings stem from three common but distinct metrics. First, dollar-value losses of enhanced premium tax credits focus on federal funding that flows to enrollees and thus highlight large-population states with big Marketplace uptake, producing lists where Texas and Florida top the chart ^[3]. Second, percentage drops in subsidized enrollment or uninsured-rate increases emphasize proportional harm to coverage among low-income populations, often flagging smaller or high-percentage-change Southern states like Mississippi and South Carolina ^{[1] [6]}. Third, economic ripple effects translate subsidy reductions into job and output losses, as in the Commonwealth Fund and Becker’s summaries that estimate job losses tied to lower health-sector revenue ^{[5] [3]}. Each measure is valid but answers a different policy question: fiscal exposure, health coverage, or broader economic consequences.

4. Recent dates and the balance of evidence — which sources are newest and what they add

The most recent entries in the dataset are November 2025 pieces that reiterate KFF and Commonwealth Fund-style findings linking enrollment growth states to large subsidy dependency, bringing updated modeling and emphasizing states that saw most of the post-enhanced-subsidy enrollment gains—Texas, Florida, Georgia, and North Carolina among them ^{[4] [7]}. Earlier 2025 analyses (March–October) supplied state dollar estimates and ranking lists that remain consistent in flagging Texas and Florida as large-dollar exposures ^{[3] [5]}. The accumulation of mid-to-late 2025 analyses narrows uncertainty: while precise dollar totals and ranking orders vary, the pattern of concentrated harm in a handful of large-population Sun Belt and Southern states is stable across dates and methods ^{[2] [4]}.

5. Potential agendas, caveats, and what the analyses omit that policymakers should watch

Some sources emphasize coverage loss and consumer harm, which can support arguments for extending subsidies to protect access ^{[1] [2]}. Others quantify economic losses to make a fiscal and jobs-based case for extension or mitigation ^{[3] [5]}. Absent from these summaries are detailed breakdowns of which income brackets or demographic groups within states bear the largest premium increases, how state-level policy choices (Medicaid expansion status, state exchange decisions) interact with subsidy cliffs, and the behavioral responses of enrollees facing higher premiums; where mentioned, these interactions materially affect outcomes but are not uniformly modeled ^{[7] [8]}. Policymakers deciding whether to extend subsidies need both the headline state rankings and these omitted distributional details.

6. Bottom line for readers trying to answer the original question now

If the question is which states will lose the most dollars, Texas and Florida top most dollar-based rankings, followed by Georgia, Tennessee, and Louisiana, with the largest proportional enrollment and uninsured-rate shocks concentrated in Mississippi, South Carolina, and other Southern states. If the question is which states will lose the most coverage or see the largest percentage increases in the uninsured, smaller Southern states dominate. All reports agree the impact is geographically concentrated and significant; the difference lies in whether you prioritize federal-dollar exposure, enrollment counts, uninsured-rate changes, or economic ripple effects ^{[3] [1] [2] [4]}.