Story perspectives

ACA Enrollment Falls to 19.2 Million After Fraud Crackdown, Subsidy End

6/30/2026

Summary

ACA Enrollment Drops

ACA marketplace enrollment fell to 19.2 million in February 2026, a 13 % drop from 22.1 million a year earlier.
Health and Human Services (HHS) says a fraud crackdown ending subsidies for about 2.9 million improperly enrolled people and the Jan. 1 2026 expiration of enhanced premium tax credits, which lifted monthly premiums 58 % from $113 to $178, drove the loss.
KFF projects enrollment will fall to 17.5 million by the end of 2026 if the trend continues.

Summary

Trump Rule Verifies

The 2025 Marketplace Integrity and Affordability Rule, issued by President Donald Trump, added tools to verify subsidy eligibility.
ACA Exchanges grew sharply from 2021-2024, but nearly half of enrollments were later deemed improper or fraudulent, peaking at 5.6 million in 2025 with 2.6 million remaining, including over 1 million lacking a Social Security number.
Current ACA Exchange enrollment is 19.2 million—the highest before 2024—and multiple agencies use data-matching to keep subsidies with eligible recipients.

History

Historical Context

In 1997 the federal government allocated $100 million to fund over 400 FBI agents targeting Medicare fraud, leading to the 2007 creation of the Medicare Fraud Strike Force and the 2009 Health-Care Fraud Prevention and Enforcement Action Team. Subsequent large takedowns in 2010-2011 recovered hundreds of millions, establishing a precedent for today’s ACA marketplace integrity crackdown.

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ACA Enrollment Drops

ACA marketplace enrollment fell to 19.2 million in February 2026, a 13 % drop from 22.1 million a year earlier.
Health and Human Services (HHS) says a fraud crackdown ending subsidies for about 2.9 million improperly enrolled people and the Jan. 1 2026 expiration of enhanced premium tax credits, which lifted monthly premiums 58 % from $113 to $178, drove the loss.
KFF projects enrollment will fall to 17.5 million by the end of 2026 if the trend continues.

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