How much more are ~75,000 NEW MEXICO ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and recently it was confirmed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of February have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plana with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at NEW MEXICO:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

It's vitally important to understand that New Mexico is truly unique: While some states have either established or beefed up their own supplemental state subsidy programs for ACA enrollees as a response to the expiration of the enhanced federal tax credits, New Mexico is the only one which is fully backfilling 100% of the lost subsidies for 100% of all ACA enrollees who were eligible for them last year.

When I say all enrollees, I'm not just talking about those who earn 100 - 400% FPL; I'm also talking about enrollees who earn more than 400% FPL as well as eligible enrollees who earn less than 100% FPL (all of the former and most of the latter had their federal subsidy eligibility cut off by the Trump Regime starting January 1st).

Even more impressive: New Mexico is doing this in addition to their existing "Turquoise Care" state-based Cost Sharing Reduction (CSR) program.

And finally, all of the above is in addition to the state also having a robust Premium Alignment pricing policy!

As a result of all of this, New Mexico is one of a handful of states which has seen their enrollment increase year over year...and is the only state to seen it increase by double digits! Plan selections during Open Enrollment actually jumped by as much as 33% in some income brackets, although it did drop somewhat over the 400% FPL threshold.

Overall, OEP plan selections increased by 18.1% year over year, from ~70,000 during OEP 2025 to more than 83,000 this year, although effectuated enrollment was down to ~75,000 as of June.

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. It's important to note that unlike other states where I have plans broken out by the more traditional metal levels & CSR tiers, due to New Mexico's unique Turquoise Plan arrangement, I have them broken out a bit differently.

Usually, the categories are: Catastrophic, Bronze, Silver (standard), Silver CSR 73, Gold, Silver CSR 87, Platinum, Silver CSR 94 ranging from 55% - 94% AV.

However, New Mexico didn't offer Catastrophic plans or official Platinum plans either year, and they've baked their state subsidies into the other plans, so they have Bronze, Expanded Bronze, Silver (base), Gold (base) Gold T3, Silver T2 and Silver T1, ranging from 60 - 99% AV.

With that in mind, here's how that breaks out year over year...and thanks to the combination of Premium Alignment, Turquioise Care and fully backfilled premium tax credits, the average Actuarial Value for New Mexico enrollees has actually increased this year, from 87.8% to 89.8%!

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like the table below.

IMPORTANT: The average per enrollee state subsidies for both premiums and CSR assistance below are rough and are based on this Health Care Affordability Fund Annual Report, though the math is a bit tricky and it makes certain assumptions. I've asked BeWell NM, the state ACA exchange, for clarification and may have to update the table below if it turns out I miscalculated.

Assuming I have my estimates correct, the impact is stark: Without the state stepping up, average net premiums would have nearly doubled year over year...but thanks to them, net premiums only went up 6.5% overall. Similarly, thanks to the state stepping up with Turquoise Care, by my very rough estimates, average out of pocket expenses have only increased by around 3.8%.

Combined, to the best of my calculations, New Mexicans are only paying around $135 more apiece this year than last on average...when it would have been more like $1,900 each otherwise.

Next up: NEW YORK.