Significant Drop in Affordable Care Act Health Insurance Enrollments for 2026

TL/DR –

Data shows a significant drop in enrolment in Affordable Care Act (ACA) health insurance for 2026, with five million fewer people enrolled compared to the previous year. This decline is attributed to increased premiums after extra financial support was not extended by the Trump administration and the Republican Congress. Despite allegations of enrollment fraud by the Paragon Health Institute, many experts believe the reduction is due to affordability issues, particularly as premium costs doubled from 2025 to 2026 after Republican lawmakers let enhanced premium tax credits expire.

Decrease in Enrollment Numbers for Affordable Care Act Insurance Plans

New data reveals a significant decrease in enrollment numbers for Affordable Care Act (ACA) health insurance for 2026. A total of 5 million fewer people have enrolled in ACA marketplace plans compared to the record numbers from the previous year. This constitutes a 13% drop in enrollment, according to Cynthia Cox, the director of KFF’s Program on the ACA. The Department of Health and Human Services published the data on its website.

The decrease followed a surge in prices as Republicans in Congress and President Trump failed to continue extra financial support for enrollees. The expired enhanced tax credits, which helped to offset premium costs, contributed to rises in insurance prices, leading more people to disenroll or fail to pay their premiums.

Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, highlights the lack of evidence for claims of fraud accounting for the decrease in enrollment numbers. Instead, she attributes the decline to consumers being unable to afford increased premiums.

Consequences of Decreased Enrollment

The decline in enrollment numbers can negatively affect insurance companies. Several companies, including Cigna, have already announced their decision to discontinue participation in ACA markets next year. Healthy people are more likely to drop their coverage, which can destabilize the market and potentially lead to a “death spiral”.

However, Cox does not foresee a “death spiral” and believes that existing ACA marketplace customers will keep the markets functioning. Despite this, she indicates that ongoing increases in premiums might continue to impact consumers and further reduce enrollment numbers. According to Pogue’s analysis, insurance rates will likely increase again next year.

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