Enrollment Decline in ACA Plans: Challenges and Legislative Responses

Enrollment in Affordable Care Act (ACA) plans declined by three million from 2025 to February 2026, according to the Department of Health and Human Services data published by The Associated Press. This reduction marks the largest drop the subsidized insurance market has experienced since the ACA's inception. The 13% decrease in coverage, from 22.1 million in 2025 to 19.2 million in 2026, reflects significant changes impacting healthcare accessibility.

The federal government attributes part of the decline to actions against fraudulent enrollments. However, industry experts point to the expiration of enhanced federal subsidies on January 1, 2026, as a critical factor. These subsidies had been essential for many families since 2021. Cynthia Cox, Vice President and Director of the ACA program at KFF, noted, "We know real people lost their health insurance coverage," as many faced substantially higher premiums. The Kaiser Foundation estimates that the average enrollee's out-of-pocket premium costs could more than double in 2026, jumping by 114% from roughly $888 annually in 2025 to about $1,904.

Impact and Legislative Response

KFF projects ongoing reductions in coverage could decrease enrollment to 17.5 million by the year's end, translating into nearly five million fewer insured individuals compared to the 2025 peak. Florida, with 4.7 million enrollees in 2025, saw significant impacts, as 97% received subsidies. This underscores the ACA market's importance to low-income workers, freelancers, and small businesses. Although congressional discussions in late 2025 attempted to renew these critical subsidies, efforts led by some Democrats and moderate Republicans failed.

In January, the House passed a bill to extend the subsidies for three more years, with a 230 to 196 vote including support from 17 Republicans. However, three Cuban-American representatives from Florida opposed the extension. Meanwhile, President Trump proposed the Great Health Plan, aimed at replacing the ACA by providing direct funds to citizens for insurance purchases and significantly reducing drug costs. As of now, this proposal awaits congressional approval, leaving uncertainties around regulatory compliance and coverage for pre-existing conditions.

With the November 2026 legislative elections approaching, healthcare affordability remains a critical concern among voters. The cost of health insurance is poised to become a central topic in political debates, accentuating the need for actionable solutions to stabilize the insurance markets.