Declining Enrollment in ACA Plans Due to Rising Premiums and Subsidy Cuts

Over 3 million individuals have discontinued their coverage under Affordable Care Act (ACA) plans this year, following an increase in premiums and the conclusion of temporary subsidies that had reduced costs for policyholders. According to the U.S. Department of Health and Human Services (HHS), the number of enrollees was approximately 19.2 million as of February, a decline from 23.1 million at the beginning of 2026, and 24.2 million in January of the previous year. The termination of the enhanced subsidies at the end of 2025 contributed to higher insurance costs for many, as reported by HHS's assistant secretary for planning and evaluation. Additionally, measures were taken to address improper enrollments in the program. HHS highlighted that the growth in ACA enrollment from 2021 to 2024 included numerous unverified or fraudulent signups. The previous administration's steps eliminated subsidies for about 2.9 million people who were ineligible. However, analysts suggest that rising costs significantly impacted enrollment declines. Without the subsidy extension, average costs for insureds under ACA escalated by 114% in 2026, according to data from KFF, a health policy research organization. Sabrina Corlette, co-director at Georgetown University's Center on Health Insurance Reforms, noted, "When costs increase, it is common to see a reduction in the number of people maintaining their insurance." Cynthia Cox, vice president and director of the ACA program at KFF, supported this view, indicating that industry forecasts anticipated a significant reduction in enrollment as affordability became a challenge. Specifically, enrollment figures based on actual payment fell to 19.2 million from 22.1 million during the same annual period. Financial pressures on households, exacerbated by general living expenses, are likely to influence further declines throughout the year. A KFF survey showed that 17% of enrollees doubted their ability to afford premiums for the full year of 2026. A report by Georgetown suggests additional premium increases are expected next year. Upon examining insurer filings across nine states and the District of Columbia, proposal submissions indicated potential rate hikes for 2027, ranging from 6.5% in Vermont to 22.4% in Washington State. Submissions for the federal marketplace are anticipated soon. HHS reports aim to ensure that subsidies reach only eligible recipients, blocking 1.5 million improper subsidy distributions and preventing another 1.4 million ineligibly enrolled individuals from receiving benefits. However, an estimated 2.6 million discrepancies might persist within enrollment records, lacking further specific details from the report. Additionally, the Centers for Medicare & Medicaid Services documented approximately 342,000 complaints in 2025 concerning unauthorized plan enrollments. Despite persistent fraud issues, financial constraints appear to be the principal factor influencing coverage termination, as emphasized by Corlette, who remarked on the significant number of consumers unable to sustain health insurance due to pricing issues.