New Federal Data Show ACA Enrollment Down Nearly 3 Million As Subsidies Expire
New federal data show Affordable Care Act enrollment fell by nearly 3 million people over the past year after enhanced pandemic-era premium subsidies expired.[1]
The loss is slightly larger than earlier federal estimates of about 2.6 million and came as premiums jumped at the start of 2026 when Congress allowed the temporary subsidies to lapse.[1] A KFF review of insurer filings found a median proposed 14% premium increase for 2027 and said the median hike for 2026 was 20%, meaning two straight years of double-digit increases if regulators approve the filings.[2]
The enhanced premium tax credits were enacted in the American Rescue Plan Act of 2021 and then extended through Dec. 31, 2025, by the Inflation Reduction Act of 2022. Those temporary credits removed the 400% federal poverty level income cap and cut the share of income households paid toward premiums. H.R. 1, enacted in 2025, narrowed premium tax credit eligibility for many lawfully present noncitizens for coverage beginning in 2026, and no further extension passed before the credits expired on Jan. 1, 2026. Net effectuated enrollment fell from 22.1 million in 2025 to 19.2 million as of February 2026. That change was entirely attributable to removing or blocking about 2.9 million improper and phantom enrollments through program integrity measures during 2025 to February 2026.
State-by-state figures cited in recent federal reports showed the marketplace shrank by more than 2.5 million, with some states losing nearly one-third of enrollees.[2] CBS's update put the national decline at nearly 3 million, a slightly larger number than the earlier tally.[1] Analysts warn middle-income households above 400% of the federal poverty level will face the full brunt of higher premiums now being proposed by insurers.[2]
The mainstream summary does not mention the significant role of program integrity measures in the enrollment decline, which accounted for the removal of approximately 2.9 million improper and phantom enrollments. This detail underscores that the net decline in ACA marketplace enrollment—from 22.1 million in 2025 to 19.2 million in February 2026—was not solely due to the expiration of enhanced subsidies but also involved a significant clean-up of the enrollment rolls. The analysis from ASPE/HHS highlights that this adjustment complicates the narrative of a simple drop in coverage due to financial factors alone, suggesting deeper systemic issues at play in the ACA's enrollment dynamics. Furthermore, while the summary notes the median proposed premium increases, it does not address the broader implications of these hikes, such as the projected 114% rise in average annual premium payments for subsidized enrollees, which could lead to 4.8 million people becoming uninsured in 2026 according to Urban Institute researchers. This stark projection indicates a looming healthcare affordability crisis that could reverse gains made in previous years and exacerbate coverage losses beyond what the mainstream account conveys.
Show source details & analysis (3 sources)
📊 Relevant Data
The net decline in ACA marketplace effectuated enrollment from 22.1 million in 2025 to 19.2 million as of February 2026 was entirely attributable to the removal or blocking of approximately 2.9 million improper and phantom enrollments through program integrity measures.
ACA Exchange Enrollment in 2026 — ASPE/HHS
📌 Key Facts
- On Wednesday, July 8, 2026, a KFF analysis found a median proposed premium increase of 14% for 2027 ACA plans across bronze, silver, gold and platinum tiers, and noted the median premium hike for 2026 was 20% — meaning 2027 would be a second consecutive year of double‑digit increases if proposed rates are approved.
- Insurers cited mounting healthcare costs — including hospital care, prescription drugs, workforce expenses, sicker enrollees and overall inflation — and the January 2026 expiration of enhanced pandemic‑era ACA subsidies as factors, saying the loss of tax credits prompted many healthier enrollees to leave the marketplaces and left a smaller, sicker risk pool.
- New Trump administration state‑by‑state data indicate the ACA marketplace shrank by more than 2.5 million people over the past year, with some states seeing enrollment declines approaching one‑third.
- CBS reports that Affordable Care Act enrollments are now down by nearly 3 million people compared with the prior year, a slightly larger decline than the previously cited 2.6 million.
- The CBS report says premiums jumped at the start of 2026 after Congress allowed COVID‑era federal premium subsidies for ACA plans to expire.
- The PBS article warns that middle‑income households above 400% of the federal poverty level (about $63,000 for an individual and $129,000 for a family of four) who no longer qualify for subsidies will bear the full brunt of the proposed premium hikes.
📰 Source Timeline (3)
Follow how coverage of this story developed over time
- CBS reports that new federal data show Affordable Care Act enrollments are now down by nearly 3 million people compared with the prior year, a slightly larger decline than the previously cited 2.6 million.
- The article states that premiums jumped at the start of 2026 after Congress allowed COVID-era federal premium subsidies for ACA plans to expire.
- CBS frames the enrollment decline and premium increases together, underscoring that the end of temporary subsidies is a key driver of people dropping marketplace coverage as of early 2026.
- On July 8, 2026, KFF released an analysis of 77 ACA insurers' 2027 rate filings in 16 states plus Washington, D.C., finding a median proposed premium increase of 14% across bronze, silver, gold and platinum plans.
- KFF found that the median premium hike for 2026 ACA marketplace plans was 20%, meaning 2027 would be the second consecutive year of double‑digit increases if proposed rates are approved.
- Insurers cited mounting healthcare costs, including hospital care, prescription drugs, workforce expenses, sicker enrollees and overall inflation, as the primary drivers of the proposed 2027 premium increases.
- Insurers also pointed to the January 2026 expiration of enhanced pandemic-era ACA subsidies as a factor, noting that the loss of tax credits led many healthier enrollees to leave the marketplaces and left a smaller, sicker risk pool.
- New Trump administration state‑by‑state data referenced in the article indicate the ACA marketplace shrank by more than 2.5 million people over the past year, with some states experiencing enrollment declines approaching one‑third.
- The article underscores that middle‑income households above 400% of the federal poverty level (about $63,000 for an individual and $129,000 for a family of four) who no longer qualify for subsidies will bear the full brunt of the proposed hikes.