In a significant shift, approximately 3 million fewer individuals in the United States enrolled in Affordable Care Act (ACA) health insurance plans as of February compared to the same period last year, according to newly released federal data from the U.S. Department of Health and Human Services. This represents a 13% decrease in enrollment, plummeting from 22.1 million in 2025 to just 19.2 million in 2026.
Health experts attribute this decline primarily to the expiration of federal subsidies on January 1, which led to sharp increases in monthly premiums that many individuals could no longer afford. Cynthia Cox, vice president and director of the ACA program at the healthcare research nonprofit KFF, highlighted that survey data indicates a direct correlation between the premium hikes and the loss of health insurance coverage for many Americans. “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments,” she stated.
The recent data, which reflects enrollment status as of February but was compiled in April, marks the first official acknowledgment of how skyrocketing costs affected individuals who struggled to pay their first bills this year. It comes after a grace period for nonpayment ended, further revealing the resultant impact on total ACA enrollment.
Earlier in January, a federal estimate had already pointed to a decline of approximately 800,000 individuals who enrolled in ACA plans compared to the same time last year. This was a notable first for a four-year stretch during which enrollment had consistently risen annually during that period.
Cox foresees ongoing declines throughout 2026, predicting that total enrollment could dwindle to around 17.5 million. Such a decrease would represent a significant contraction for the ACA, which has become a vital option for working-age individuals who do not qualify for Medicaid, including gig workers, farmers, ranchers, and hairstylists who lack employer-sponsored health coverage.
The expiration of the ACA subsidies sparked intense debate in Congress last fall, with both Democratic and some Republican lawmakers advocating for their renewal. This rising tide of health care costs, keenly felt by millions, has emerged as a pressing concern among voters leading up to the upcoming November elections, amplifying calls for solutions to address affordability within the healthcare system.
