New federal data released in late June 2026 confirms that roughly five million fewer people are enrolled in Affordable Care Act marketplace plans compared with last year's record high, after enhanced premium tax credits expired at the end of 2025. Average premium payments rose 58% while enrollment fell from a peak of 24.2 million to 19.2 million, raising fears of market instability and renewed political conflict ahead of the midterm elections.
The United States is experiencing the steepest single-year decline in Affordable Care Act (ACA) marketplace enrollment since the program launched, according to federal data released on June 26, 2026, and analyzed by health policy researchers. The Department of Health and Human Services reported that 19.2 million people remain enrolled in ACA insurance in 2026 — down from a record high of 24.2 million in 2025. More than one million fewer people selected a plan during open enrollment, and an additional four million either actively disenrolled or lost coverage after failing to pay their premiums.
The primary driver was the expiration of enhanced premium tax credits, which had been first enacted in 2021 and were allowed to lapse at the end of 2025 after Congress failed to extend them. The political fight was intense: Democrats forced a government shutdown in October 2025 in an unsuccessful attempt to negotiate a three-year extension of the credits. With the subsidies gone, average premium payments rose by approximately 58% — climbing from $113 to $178 per month, according to KFF analysis. While significant, this increase was smaller than the 114% spike KFF had initially projected, largely because many households switched to cheaper, higher-deductible bronze plans (bronze enrollment jumped from 7.3 million to 9.2 million) and because those facing the steepest increases dropped coverage entirely.
The impact has been concentrated among middle-income Americans just above the 'subsidy cliff' (400% of the federal poverty level), who no longer qualify for any premium assistance. This group made up just 7% of 2025 enrollment but accounted for nearly half (48%) of the decline in plan selections. Average deductibles also rose 37%, reaching a record $3,786 per person.
The Trump administration has attributed much of the decline to anti-fraud efforts, noting that improper enrollments fell from 5.6 million in 2025 to 2.6 million in 2026. However, independent health policy experts at KFF and Georgetown's Center on Health Insurance Reforms dispute this, arguing that the data points overwhelmingly to affordability as the cause. The loss of younger, healthier enrollees has prompted several insurers — including Cigna — to announce plans to exit certain ACA markets next year, and early 2027 rate filings suggest premiums will rise again, raising concerns about a potential market 'death spiral.'
Key Points
- 1ACA marketplace enrollment fell to 19.2 million in 2026, down from a record 24.2 million in 2025
- 2Roughly 5 million fewer people are enrolled after enhanced premium tax credits expired at end of 2025
- 3Average premium payments rose 58%, from $113 to $178 per month, per KFF
- 4Middle-income enrollees just above the 400% FPL subsidy cliff drove nearly half the decline
- 5Insurers including Cigna plan to exit some ACA markets, and 2027 rate filings point to further increases
Why This Matters
The ACA marketplace is the primary source of health coverage for self-employed workers, gig workers, early retirees, and millions of working-age Americans who don't get insurance through an employer. A loss of coverage on this scale has direct consequences for household financial security and access to care. For insurers, the departure of healthier, younger enrollees raises the risk of a deteriorating risk pool that could push premiums even higher. The issue is also shaping up to be a central theme in the 2026 midterm elections.
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