Enrollment Declines Under ACA Due to Rising Premiums and Subsidy Expiration
In 2026, more than 3 million individuals have exited Affordable Care Act (ACA) plans, mainly due to rising premiums and the end of enhanced subsidies which had previously increased accessibility. According to the U.S. Department of Health and Human Services (HHS), ACA enrollment figures stood at around 19.2 million in February 2026, dropping from the 23.1 million recorded in January. A year prior, enrollment numbers had reached 24.2 million in January.
The expiration of enhanced subsidies at the end of 2025 led to greater financial burdens on policyholders. An HHS report revealed initiatives to rectify improper enrollments, indicating that nearly half of the ACA's increased enrollment from 2021 to 2024 might have been attributable to fraudulent activities. Previous administration measures successfully prevented 2.9 million individuals from obtaining undeserved subsidies.
Industry analysts attribute the enrollment decline primarily to affordability issues. With Congress deciding against prolonging enhanced subsidies, ACA participants experienced an average cost increase of about 114% in 2026, as per the Kaiser Family Foundation (KFF). Sabrina Corlette from Georgetown University's Center on Health Insurance Reforms stated, “It’s a simple fact that when you raise prices for a good or service, fewer people are going to buy it.”
Both private insurers and the Congressional Budget Office anticipated a drop in enrollment as consumers were required to bear higher costs to retain their coverage. Cynthia Cox, a KFF vice president, confirmed this expectation, noting that such a decrease had been forecasted earlier in the year.
Cox also distinguished between initial enrollments and active coverage maintenance, with the latter reducing from 22.1 million in 2025 to 19.2 million by February 2026. KFF foresees additional declines as some consumers struggle to juggle premium payments alongside other financial commitments, such as housing and groceries. Furthermore, 17% of surveyed individuals expressed doubts about sustaining premium payments throughout 2026.
Looking forward, a Georgetown’s Center on Health Insurance Reforms report projects further premium hikes for 2027, varying by state from 6.5% in Vermont to 22.4% in Washington. Federal marketplace insurer filings are anticipated later in the year.
On the regulatory front, HHS chronicled efforts during the previous administration to ensure proper allocation of subsidies to eligible enrollees, thwarting over 2.6 million fraudulent enrollments. This included cases without Social Security numbers, though exhaustive report details were absent. In 2025, CMS received nearly 342,000 complaints about "unauthorized enrollment," where individuals were enrolled without their consent.
While fraudulent activities present notable challenges, Corlette reiterated that affordability remains the predominant factor prompting consumers to abandon their coverage. “The numbers are bad,” she remarked, stressing the burgeoning difficulty for millions in sustaining affordable health insurance.