The U.S. Department of Health and Human Services attributed much of the decline to efforts targeting improper and fraudulent enrollments. Health policy analysts, meanwhile, said the expiration of enhanced federal subsidies on Jan. 1 sharply increased premiums for many consumers, making coverage unaffordable for some households.
Federal Data Shows Enrollment Decline After Subsidy Expiration
According to the U.S. Department of Health and Human Services, approximately 19.2 million Americans were enrolled in Affordable Care Act exchange plans in February 2026, compared with 22.1 million one year earlier. The figures, compiled in April and released Friday, provide the first official picture of enrollment after the grace period for unpaid premiums had ended.
The department said the 13% decline reflected, in part, a broad effort to remove improper, phantom, and fraudulent enrollments from the marketplace. In a June 2026 issue brief, HHS estimated that program integrity measures had prevented or ended subsidies for roughly 2.9 million individuals who were previously receiving benefits without qualifying for them. According to the department, an estimated 1.5 million people lost subsidies after eligibility reviews, while another 1.4 million enrollments were blocked or removed through additional enforcement measures.
The issue brief also states that enrollment remains above pre-2024 levels despite the decline. HHS estimated that 19.2 million people remained enrolled in ACA exchange plans as of February 2026, while acknowledging that improper or fraudulent enrollment may still persist within the program.
Health Analysts Point to Higher Premiums as a Major Factor
Health policy researchers offered a different explanation for the enrollment decline, linking it primarily to the expiration of the enhanced Affordable Care Act subsidies that had lowered premiums for millions of consumers through the end of 2025.
According to the Associated Press, Cynthia Cox, vice president and director of the ACA program at KFF, said survey findings indicate that many people lost coverage because they could no longer afford their monthly premiums after federal assistance expired. She said millions of consumers experienced double- or triple-digit increases in premium payments when the subsidies ended.
“We know that real people lost their health insurance coverage,” Cox said, according to the Associated Press. “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments.”
Earlier federal enrollment estimates released in January had already suggested a slowdown, showing roughly 800,000 fewer plan selections than at the same point in the previous enrollment period. According to the Associated Press, KFF expects total ACA marketplace enrollment to continue declining during 2026, potentially reaching about 17.5 million people by the end of the year.
The expiration of the enhanced subsidies had been the focus of a contentious congressional debate the previous year, with Democrats and some Republicans supporting an extension. The enrollment decline comes as affordability remains a leading concern for voters ahead of the November elections, while Affordable Care Act marketplace plans continue to serve workers who do not receive health insurance through an employer, including gig workers, farmers, ranchers, and self-employed professionals.
