Millions drop ACA coverage amid price jump

More than 3 million people enrolled in an Affordable Care Act plan this year have dropped their coverage amid higher monthly premiums and the expiration of enhanced subsidies that made the health insurance plans more affordable.

The U.S. Department of Health and Human Services reported that about 19.2 million were enrolled in an ACA plan as of February, down from 23.1 million who signed up for coverage by January 2026. About 24.2 million signed up in January 2025.

While the expiration of the enhanced ACA subsidies at the end of 2025 made insurance more expensive for millions of consumers, the HHS assistant secretary for planning and evaluation report cited efforts to crack down on improper signups.

The report said nearly half of the ACA enrollment growth from 2021 to 2024 was "suspected to be improper, phantom or fraudulent."

The HHS report said Trump administration efforts blocked the enrollment of 2.9 million people who were "improperly receiving subsidies they did not qualify for."

But experts who track ACA enrollment said affordability probably was the driving force behind the drop in enrollment. When Congress failed to extend the enhanced subsidies that expired at the end of 2025, average costs for ACA enrollees who wanted to keep their insurance plans soared 114% in 2026, according to KFF, a health policy nonprofit.

"It's a simple fact that when you raise prices for a good or service, fewer people are going to buy it," said Sabrina Corlette, codirector of Georgetown University's Center on Health Insurance Reforms. "That's what we're seeing with health care."

Private health insurers that sell ACA plans and the nonpartisan Congressional Budget Office also forecast big enrollment drops because consumers had to pay more to keep their insurance plans, said Cynthia Cox, vice president and director of the program on the ACA at KFF.

The enrollment drop "really isn't surprising," Cox said. "The numbers are in line with what everyone expected going into this year."

How much did enrollment drop?

Cox said the there's a difference between the number of consumers who sign up for a plan and those who make a monthly payment, which is required to maintain coverage. Coverage for individuals who sign up for an ACA plan is terminated if they fail to make monthly payments.

When comparing the number of people who "effectuate" enrollment by making a monthly payment, enrollment dropped from 22.1 million in 2025 to 19.2 million people in February 2026.

KFF projects that enrollment will probably drop even more as some struggle to make monthly payments while facing other expenses, such as housing costs and grocery bills. A KFF survey found 17% of enrollees were not confident that they could afford their health insurance premiums for all of 2026.

A Georgetown Center on Health Insurance Reforms report published June 18 suggests that health insurers will probably raise rates again next year. Georgetown researchers analyzed health insurer filings in nine states and Washington, D.C. Insurers in those states sought rate increases for 2027 coverage that will range from 6.5% in Vermont to 22.4% in Washington state. Insurer filings for the federal marketplace, which covers must Americans, aren't due until mid-July.

Why is HHS citing fraud?

HHS cited Trump administration efforts to ensure federal subsidies are going toward enrollees who qualify. Those efforts prevented 1.5 million enrollees from getting subsidies they did not qualify for and ended or blocked an additional 1.4 million enrollees, HHS said.

HHS estimated that 2.6 million "improper and phantom enrollments" might still be in place, including signups without a Social Security number. The HHS report did not provide further details or evidence on these figures.

In a document submitted to the Federal Register, the Centers for Medicare & Medicaid Services said it fielded nearly 342,000 complaints in 2025 involving "unauthorized enrollment." That describes cases in which a broker enrolled a consumer in an ACA plan without their consent.

While fraud remains a problem, Corlette said she believes most consumers are dropping coverage because of affordability concerns.

"The numbers are bad," Corlette said. "It doesn't look good when millions of people are unable to afford health insurance."