When the state of Minnesota announced last fall that monthly premiums on MNsure, the state’s healthcare exchange borne out of the Affordable Care Act, would skyrocket 57%, state officials and healthcare advocates warned that an untold number of Minnesotans could no longer afford their insurance.

At a board meeting last week, MNsure officials released the toll so far:

• There were 125,714 effectuated enrollments as of May, a 12% decline compared to May 2025, when there were 142,977 such enrollees. Effectuated is jargon for someone who not only has signed up for a health insurance plan but has also paid their first month’s premium.

• Over 170,000 people have signed up for MNsure, but some of them are not accessing health insurance because they did not pay their premium.

People are on the 12-year-old MNsure program because they do not get health insurance from their employer. They also make too much to qualify for Medical Assistance, the state’s Medicaid program, or MinnesotaCare, which offers health plans to residents who make less than 200% of the federal poverty level.

Minnesota’s figures jibe with federal Health and Human Services numbers. Affordable Care Act marketplace enrollment is down 13% nationally, according to the federal figures.

A report by KFF, a healthcare policy-focused nonprofit, noted that 2026 is the first time the number of enrollees has dropped since the first Trump administration. Previously, enrollment numbers were on the rise.

KFF lays the blame largely on the expiration of an enhanced federal subsidy for people who enroll in the healthcare marketplace.

There are other factors at play, at least in Minnesota, for rising costs. These include the collateral effects of rising drug prices and a state taxpayer fund that helps health insurers with pricey claims.

Beyond a dip in the number of health marketplace enrollees, MNsure provided preliminary evidence that enrollees opted for cheaper plans.

The marketplace has gold, silver and bronze plans. Gold plans have the most expensive premiums (and, in theory, most complete coverage).

Of the enrollees who stayed at their “medal level,” 52% chose a less expensive plan, according to MNsure. There was also a 112% increase in consumers “buying down” to a cheaper medal level, MNsure said, compared with the change between 2024 and 2025.

This article first appeared on MinnPost and is republished here under a Creative Commons license.