New federal data show that enrollment in Affordable Care Act marketplace health plans fell sharply in early 2026, marking a notable decline for one of the federal government’s main health insurance programs for people who do not receive coverage through an employer.
According to a report released Friday by the U.S. Department of Health and Human Services, 19.2 million people had ACA plans in February, down from 22.1 million at the same point in 2025. The decrease of about 3 million people represents a 13% drop.
HHS said the decline may be linked to federal efforts to address fraudulent or “phantom” enrollments. Some health policy analysts, however, pointed to another likely factor: the expiration on Jan. 1 of enhanced federal subsidies that had helped lower monthly premiums for many enrollees. Without those subsidies, some consumers saw premium payments rise by double or even triple digits, making coverage harder to maintain.
The February figures are the first official federal snapshot showing the impact of nonpayment after the grace period for initial premiums ended. Earlier federal estimates in January had already indicated that about 800,000 fewer people had selected ACA plans than during the same period the year before.
Cynthia Cox, vice president and director of the ACA program at KFF, said survey data indicate that some people who left the marketplace lost actual health coverage. KFF expects enrollment could continue falling during the year, possibly reaching about 17.5 million.
ACA marketplace plans are used by many working-age Americans who do not qualify for Medicaid and lack employer-sponsored insurance, including gig workers, farmers, ranchers and self-employed professionals.
The subsidy expiration followed a congressional debate last fall, when Democrats and some Republicans supported extending the assistance. The enrollment decline comes as health care costs and broader affordability issues remain concerns ahead of November elections.