The federal government has reported that by 2026, 19.2 million people will still have insurance through the Affordable Care Act (ACA). This marks a notable decrease from the 24.2 million people enrolled in 2025, according to data released by the Department of Health and Human Services.
Significant Enrollment Drop
Current figures show a reduction of five million enrollees compared to last year’s peak. The decline occurred as over one million fewer individuals selected plans for 2026, alongside four million who either disengaged or failed to maintain premium payments.
Price increases in the marketplace followed the failure of President Trump and Congressional Republicans to continue enhanced financial aid for enrollees after last year.
Impact of Expired Tax Credits
Cynthia Cox, the director at KFF’s Program on the ACA, highlights a 13% drop in enrollments from last year. She criticizes the Trump administration’s claims of fraud-related enrollment decreases, pointing instead to the premium hikes after enhanced tax credits ended.
During the pandemic, federal investment made premiums more affordable, leading to increased enrollment. The growth in enrollment was expected as government subsidies made coverage more accessible.
Economic Challenges for Enrollees
Premiums doubled on average between 2025 and 2026 after Republican lawmakers let the enhanced premium tax credits expire. Democrats attempted to extend these credits, leading to a government shutdown in October 2025.
This economic environment forced many to reconsider their coverage due to rising costs amidst general inflation. More than half of the ACA enrollees reside in Republican congressional areas.
Stacey Pogue from the Georgetown Center on Health Insurance Reforms asserts that the enrollment drop aligns more with personal financial decisions than fraud.
Industry Concerns and Market Stability
The rising premiums pose challenges for insurance companies. Some, such as Cigna, announced they will not participate in the ACA markets the following year.
Cox explains that while there is potential for a market decline if healthy individuals continue to leave, at present the market remains stable. Current participation levels suggest no immediate risk of a “death spiral,” where few insurers remain to offer coverage.
Yet, with premiums poised to rise into 2027, the trend of declining enrollments may persist. Early rate filings indicate another increase in insurance rates next year.