Millions drop Affordable Care Act coverage after costs rise

By the Editorial Team · Sunday, June 28, 2026

ACA marketplace enrollment fell by nearly 3 million individuals in February 2026 compared to the previous year, primarily due to the expiration of federal subsidies that led to sharp premium increases. This decline signals rising affordability challenges for millions relying on ACA plans, potentially threatening the program’s role as a key source of coverage for uninsured working-age adults.

Approximately 3 million fewer Americans were enrolled in Affordable Care Act (ACA) health insurance plans in February 2026 compared to the same period last year, according to newly released federal data. Enrollment dropped 13%, from 22.1 million in 2025 to 19.2 million this year, marking a significant decline for the ACA marketplace.

The U.S. Department of Health and Human Services (HHS), which published the report on Friday, attributed part of the decrease to intensified efforts to eliminate fraudulent or “phantom” enrollments. However, health policy analysts contend the primary driver was the expiration of federal subsidies under the One Big Beautiful Bill Act at the start of this year. The lapse in subsidies led to a sharp increase in premium costs, resulting in many enrollees being unable to afford their insurance plans.

Cynthia Cox, vice president and director of the ACA program at the nonprofit research organization KFF, noted the tangible impact of rising costs, saying, “We know that real people lost their health insurance coverage.” She cited survey data indicating that coverage loss coincided with premium hikes of double- or even triple-digit percentages for millions of Americans.

The figures reflect enrollment status after the nonpayment grace periods had expired, providing the first comprehensive glimpse of how premium payment challenges affected the ACA marketplace in 2026. Earlier federal estimates from January had already indicated an initial decrease of approximately 800,000 enrollees compared to the previous year during the early open enrollment period, the first such drop in four years.

KFF analysts project that ACA enrollment could continue to fall during the year, potentially declining to around 17.5 million people. Such a reduction would represent a considerable setback for the ACA marketplace, which serves as the government’s principal subsidized insurance program for working-age adults who do not qualify for Medicaid. The ACA plans have become increasingly popular among those lacking employer-sponsored coverage.

The expired subsidy program was the focus of intense political debate last fall, with Democrats and some Republicans advocating for its renewal after the Republican-backed One Big Beautiful Bill Act was passed in July 2025. The resulting premium increases come amid growing voter concern over healthcare affordability, a key issue in current political discourse.

As health costs continue to rise across insurance markets, the decline in ACA enrollment highlights ongoing challenges in maintaining accessible, affordable coverage for millions of Americans.

This article was reported by synthesizing coverage from multiple independent news outlets to present a balanced, unbiased account. Read about our editorial standards. Spotted an error? Let us know.