ACA enrollment drops by 5 million after premium subsidies expire
9 reported1 conflicting
According to data released Friday by the Department of Health and Human Services, five million fewer people are currently enrolled in Affordable Care Act marketplace plans compared to the record high reached last year. The report states that 19.2 million people are currently enrolled, down from 24.2 million in 2025. More than one million fewer people picked a plan for 2026, and four million more either disenrolled or failed to pay premiums. The drop follows the expiration of enhanced premium tax credits, which Congress did not extend, leading to premium costs that doubled on average from 2025 to 2026. Health policy experts cited in the article say the decline was predictable given the price increases, while the Trump administration attributes the drop to efforts to address fraud. Some insurance companies, including Cigna, have announced they will not participate in ACA markets next year.
What’s reported
Five million fewer people are enrolled in ACA marketplace plans compared to the record high last year.
Current enrollment is 19.2 million, down from 24.2 million in 2025.
More than one million fewer people picked a plan for 2026, and four million more disenrolled or failed to pay premiums.
Premium costs doubled on average from 2025 to 2026 after enhanced premium tax credits expired.
The Department of Health and Human Services published the data on its website Friday.
Cynthia Cox of KFF’s Program on the ACA stated that enrollment is down 13% from last year.
Stacey Pogue of the Georgetown Center on Health Insurance Reforms said she does not see data supporting that a 5 million person drop can be explained by fraud allegations.
Cigna is among insurers that have announced they will not participate in ACA markets next year.
Early insurance rate filings for 2027 show rates will increase again, according to a Georgetown analysis.
Conflicting accounts
The article notes that the Trump administration attributes the enrollment drop to efforts to address fraud, a theory advanced by the Paragon Health Institute. Many health policy experts are skeptical, saying the increase during the pandemic was a predictable consequence of Congress’s investment in premium subsidies, and that the drop is predictable given premium cost increases.
Key figures
Cynthia Cox, director of KFF's Program on the ACA
Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms
Paragon Health Institute (conservative think tank)
Sources: NPR
