ACA Marketplace Enrollment Falls Amid Dispute Over Causes
Enrollment in Affordable Care Act marketplace plans has declined for the first time in years, falling by about 3 million people, or 13%, from 22.1 million at the end of 2025 to 19.2 million in February 2026, according to new federal data.
The drop is the largest since ACA marketplaces began in 2014 and comes after enhanced federal premium subsidies expired at the end of 2025. Those subsidies, first expanded in 2021, lowered monthly costs for many enrollees and allowed some lower-income households to obtain plans with no monthly premium.
Health policy researchers say the decline is largely tied to higher costs. KFF previously estimated that premiums would more than double on average after the enhanced subsidies ended, rising from $888 in 2025 to $1,904 in 2026. Analysts say higher premiums, combined with broader cost-of-living pressures, likely led some households to drop coverage.
The Trump administration has offered a different explanation, pointing to efforts to reduce fraud, improper enrollment and broker misconduct. The Department of Health and Human Services said it identified issues such as people enrolled without their consent and cases involving missing Social Security numbers. CMS said it canceled coverage for 250,000 people who had been enrolled without permission.
Policy experts acknowledge that some fraud and improper enrollment occurred, but many question whether it explains most of the decline. They note that missing Social Security numbers can reflect lawful immigration status or data problems, and income discrepancies may result from enrollees estimating future earnings incorrectly rather than intentionally misstating them.
The issue has political significance after Congress allowed the enhanced subsidies to expire despite Democratic efforts to extend them. Republican officials say they are focused on affordability and program integrity.
Further declines may follow. The Congressional Budget Office projects ACA marketplace enrollment could fall to 12.5 million by 2028, while the uninsured rate is expected to rise later this decade.