Enrollment in the ACA marketplace fell to 19.2 million in February 2026, down from 22.1 million at the end of 2025, representing a 13% decline. This is the largest drop since the ACA was established. The decrease follows the lapse of enhanced premium subsidies that had previously made insurance more affordable.
Health policy experts argue that the loss of these subsidies is the primary reason for the decline, as many households can no longer afford the increased premiums, which rose by an average of 114% to $1,904 in 2026.
In contrast, the Trump administration attributes the decline to efforts to combat fraud, claiming that a crackdown on fraudulent enrollments has led to the cancellation of 250,000 policies. However, experts dispute this claim, suggesting that the administration is using the fraud narrative to deflect attention from the real issue of affordability.
The debate highlights the ongoing political tensions surrounding healthcare policy, especially as the GOP has allowed the subsidies to expire and made administrative changes that could further reduce enrollment. The implications of this enrollment drop are significant, as it may lead to increased uninsured rates among low-income populations, exacerbating existing healthcare access issues