Multiple states are stepping in to offer their own premium assistance programs for Affordable Care Act marketplace enrollees in 2027, aiming to offset the impact of lapsed enhanced federal subsidies. California, Colorado, Connecticut, Maryland, Massachusetts, New Mexico, New Jersey, Rhode Island, Vermont, Virginia, and Washington state are all providing some form of financial help to reduce monthly insurance premiums. Most of these states are continuing or expanding programs they introduced in 2026 in response to the federal subsidy expiration, though Rhode Island and Virginia are launching their respective initiatives for the first time in 2027.
The state-level assistance comes on top of remaining federal premium tax credits and represents an effort to address mounting affordability concerns among consumers. The programs vary significantly by state in terms of funding levels and eligibility criteria, with many targeting lower-income households. California has increased its investment to $300 million for 2027 from $190 million in 2026 and expanded eligibility to include households earning up to 200% of the federal poverty level, potentially covering an additional 200,000 residents. Massachusetts committed $620 million, described as the largest state investment nationwide. Meanwhile, New Mexico became the only state to fully replace the enhanced federal subsidies for its enrollees.
The backdrop for these state actions includes significant disruption in the ACA marketplace after enhanced federal subsidies ended at the close of 2025. Average monthly premiums jumped 58% to $178 in 2026 from $113 the prior year, according to nonpartisan research. This increase contributed to a 13% decline in ACA enrollment, which fell to 19.2 million as of February 2026 from 22.1 million the previous year, with further declines expected since then. Health policy analysts note that states offering premium assistance experienced smaller enrollment declines than those providing no additional support, suggesting the assistance programs help retain coverage among eligible consumers.
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