Seven markets.
Seven different
answers.

New Jersey's distinguishing feature is that it did not wait for Congress. The state's own subsidy program extends well up the income scale, which cushioned the 2026 shock for a broad band of middle-income households that in other states absorbed it directly.

On property, the state's numbers look better than its geography suggests. Shore exposure is real and priced accordingly at the ZIP-code level, but the statewide average remains comparatively modest — the pressure is coming from reinsurance and rebuild costs rather than from claims history.

Pennsylvania runs its own marketplace and expanded Medicaid, and still absorbed one of the harder 2026 increases in the region. The reason is the risk pool: an old state with a large rural population and a substantial share of self-employed, gig and small-business enrollees who buy individually and have no employer to absorb the shock.

The property story deserves separate attention. A 44% cumulative rise since 2021 in a state with no hurricane exposure, no wildfire exposure and modest catastrophe history is the clearest available evidence that reinsurance pricing has decoupled from local risk.

Delaware is the case study the rest of the region should be reading. It has the demographic profile of Maine or Vermont — an aging-in-place population plus heavy retiree in-migration — attached to a healthcare delivery system sized for a much smaller and much younger state. Cheap insurance and scarce care are not a contradiction here; they are the same story seen from two ends.

Sussex County is where this concentrates. The entire county is federally designated a Medically Underserved Area and a Health Professional Shortage Area, while the Lewes–Rehoboth coastal corridor absorbs some of the fastest residential growth in the state. Two companion briefs examine that collision in detail.

Maryland is the region's best argument that state policy choices change outcomes. Its reinsurance program absorbs high-cost claims before they reach the general risk pool, and the result is a market with both low premiums and — until this year — stable carrier participation.

The 2026 caveat is on the back end rather than the front. State officials have signaled an expectation that high premium payments will push more enrollees to cancel coverage outright or lose it for non-payment as the year progresses. A low sticker price does not help someone who has already dropped the policy.

The District is included here mostly as a control. It shares the region's regulatory environment and its carriers, but almost none of its demographic pressure — a young, transient, heavily employer-insured population with abundant nearby specialty care.

Its relevance to the rest of the Mid-Atlantic is comparative: when a regional average is quoted, D.C. is often pulling it in a direction that describes no other jurisdiction here.

Virginia presents the sharpest split of any state in this index. On health coverage it is among the best-positioned jurisdictions in the country: low benchmark premiums, a modest 2026 increase, and a young-enough risk pool to sustain both.

On property it took one of the worst single-year hits in America. A 37% jump in a state without Gulf hurricane exposure or Western wildfire exposure points at severe convective storm losses, rebuild-cost inflation and reinsurance repricing rather than at any one catastrophe.

West Virginia is the region's counter-example to Delaware, and the comparison is instructive. Both are old states. Delaware is old because retirees keep arriving; West Virginia is old because younger residents left and birth rates fell. Same headline share, opposite mechanics — and opposite policy implications.

The market consequence is a small, rural, high-morbidity risk pool with few competing carriers, on the federal platform, without the reinsurance or state-subsidy tools its neighbors used to blunt 2026. It is the clearest illustration in this index of what those tools are worth.