ACA Marketplace Enrollment Plummets as Enhanced Subsidies Expire

The Department of Health and Human Services reports that about five million people who secured ACA marketplace plans for 2026 have either disenrolled or missed premium payments, a 13 % decline from the prior year. As of February, 19.2 million remained enrolled, down from 23.1 million who selected plans during open enrollment. The 2025 figure was 22.3 million, indicating a steady downward trend.

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The decline follows the December 2025 expiration of pandemic-era enhanced premium tax credits, which had lowered monthly costs for most shoppers. Republican lawmakers declined to renew the subsidies, and a brief government shutdown in October 2025 stalled extension talks. Average premiums doubled from 2025 to 2026, and many middle-and higher-income enrollees faced double-digit hikes.

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The Trump administration attributes part of the loss to fraudulent enrollments, citing an ASPE estimate that improper, phantom, or fraudulent sign-ups peaked at 5.6 million in 2025. Kaiser Family Foundation (KFF) analysts argue that the simultaneous loss of subsidies and premium spikes are the primary drivers, noting that fraud exists but does not fully explain the drop. Insurers such as Cigna have announced they will not participate in the 2027 exchanges, citing a reduced customer pool.

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Democratic lawmakers and health-policy experts dispute the fraud narrative, emphasizing affordability pressures. Stacey Pogue of the Georgetown Center on Health Insurance Reforms says, “there’s lots of evidence pointing to people making decisions based on what they can pay each month.” Critics warn that the exit of healthier enrollees could destabilize risk pools and trigger a “death spiral” if insurers withdraw.

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Sources differ on attrition magnitude: HHS cites a five-million loss, while ASPE data indicates four million dropouts in the first month of coverage. The role of fraudulent enrollments in the decline remains disputed, with no consensus among agencies and analysts.

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• “The main takeaway is that enrollment is down 13% from last year,” — Cynthia Cox, director, KFF’s Program on the ACA

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• “I don't see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud,” — Stacey Pogue, senior research fellow, Georgetown Center on Health Insurance Reforms

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• “If there are fewer customers, then that makes the market less appealing to insurance companies,” — Cynthia Cox, KFF

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• “By our estimate, improper, phantom and fraudulent enrollment peaked at 5.6 million people in 2025,” — Office of the Assistant Secretary for Planning and Evaluation

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Early rate filings show premiums will rise again in 2027, and insurers including Cigna plan to exit the marketplace. Analysts warn that continued price growth could further erode enrollment, especially among healthier individuals, raising concerns about market stability.

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