Dive Brief:
- Enrollment in Affordable Care Act health plans declined by nearly 3 million people this year as policy turbulence continues to roil the exchanges, according to federal data released Friday.
- About 19.2 million people were enrolled in ACA marketplace plans in February, down about 13% from the same time in 2025.
- The Trump administration attributed the decline to efforts to prevent improper and fraudulent enrollment. But more generous financial assistance for ACA plans also expired at the end of last year, pushing more Americans to drop their plans due to rising costs, experts say.
Dive Insight:
The number of people choosing ACA coverage has become a hot topic this year, after enhanced premium subsidies lapsed last year following a heated political battle in Washington.
The enhanced tax credits, which went into effect in 2021, increased financial assistance for people already eligible for subsidies and allowed more middle-income enrollees to receive the subsidies for the first time. Additionally, the policy expanded the number of low-income people who could choose a plan with a $0 premium.
The tax credits spurred ACA enrollment growth, breaking sign-up records for four years in a row.
After the subsidies expired, premium payments rose by an average of 58%, according to data analyzed by health policy researcher KFF. Deductibles also rose, as consumers chose plans with higher out-of-pocket costs to save money.
Market watchers expected ACA enrollment to shrink this year as costs rose for enrollees, pushing them to drop their coverage or search for cheaper alternatives.
“Real people lost their health insurance or are now paying more. Our survey that followed ACA Marketplace enrollees from 2025-2026 as subsidies expired found most enrollees who changed plans did so due to costs,” Cynthia Cox, senior vice president and director of KFF’s program on the ACA, wrote on X Friday.
But the Trump administration argues falling enrollment so far is the result of fraud prevention efforts, according to the report released by the HHS’ Office of the Assistant Secretary for Planning and Evaluation. For example, the CMS finalized a regulation last summer that tightened eligibility requirements and ended a monthly special enrollment period.
Though some of the changes were struck down by a federal judge earlier this month, the “Big Beautiful Bill” codified similar policies. And the Trump administration has finalized other regulations that aim to curb fraud and abuse on the exchanges.
Improper enrollments, where enrollees misstate their income, and phantom signups — where people are unknowingly or automatically placed into free plans by brokers — peaked at 5.6 million people in 2025, according to the new federal data.
The Trump administration said it’s prevented about 2.9 million people from receiving subsidies for which they didn’t quality. However, it says around 2.6 million people are still improperly enrolled, including more than 1 million people who enrolled in plans without a Social Security number.
