ACA Enrollment Falls as Subsidy Expiration Raises Premium Costs
New federal data shows that enrollment in Affordable Care Act health insurance plans declined by about 3 million people in February compared with the same month last year. According to a report released by the U.S. Department of Health and Human Services, 19.2 million people were enrolled in ACA marketplace plans this year, down from 22.1 million in 2025, a decrease of roughly 13%.
HHS said the decline may be linked to federal efforts to address fraudulent or “phantom” enrollments. Some health policy analysts, however, pointed to another factor: the expiration of enhanced federal subsidies on Jan. 1. Those subsidies had helped lower monthly premium costs for many enrollees. After they ended, some consumers saw large increases in what they owed for coverage, including double- or triple-digit percentage increases in premium payments.
Cynthia Cox, a vice president at the health policy nonprofit KFF, said survey data indicates that some people who left ACA plans did so after losing the ability to afford coverage. KFF expects enrollment may continue to fall during the year, possibly reaching about 17.5 million people.
The February figures are significant because they reflect enrollment after a grace period for nonpayment of premiums had ended. A January federal estimate had already shown ACA enrollment down by about 800,000 compared with the prior year, marking the first year-over-year decline at that point in the enrollment period in four years.
ACA plans serve people who generally do not receive health insurance through an employer and do not qualify for Medicaid. The marketplace has become an important coverage option for self-employed workers, gig workers, farmers, ranchers, hairstylists and others.
The subsidy expiration followed a congressional debate last fall over whether to extend the financial assistance. The issue is likely to remain part of broader discussions about health care costs and affordability ahead of the November elections.