Significant Drop in ACA Enrollment as Premiums Skyrocket
The Affordable Care Act (ACA) has seen a substantial decrease in enrollment for 2026, with many opting out due to surging premium costs. This trend aligns with previous predictions by industry experts.
According to newly released data, approximately 5 million individuals who initially enrolled in ACA health coverage at the start of the year have either canceled their plans or failed to pay their premiums, resulting in loss of coverage. The Department of Health and Human Services released a report detailing these findings.
The decrease in enrollment comes after the expiration of enhanced premium tax credits, which had previously offset costs for many. Without these subsidies, premium rates have doubled on average, making it difficult for consumers to maintain their insurance plans. The situation was exacerbated when Congress did not renew these financial aids, leading to an average doubling of premium costs from 2025 to 2026.
“The main takeaway is that enrollment is down 13% from last year,” says Cynthia Cox, director of KFF’s Program on the ACA. The Trump administration’s stance is that the decline is partly due to efforts in combating fraud, yet other experts attribute it to unaffordable premiums.
The theory that fraud is behind the spike in enrollment numbers during the pandemic has been suggested by the Paragon Health Institute, but many experts dismiss this, citing the government’s investment in premium affordability as the cause for increased enrollment during that period.
Cynthia Cox further explains, “The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people.”
Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, concurs, pointing out that the decision to drop coverage is primarily driven by financial constraints rather than fraud: “I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud.”
This unfriendly economic environment, marked by ongoing inflation, has forced consumers to make difficult budgeting decisions. Insurance companies are also feeling the impact, with some, including Cigna, announcing plans to withdraw from ACA markets next year due to reduced customer numbers.
Cynthia Cox notes, “If there are fewer customers, then that makes the market less appealing to insurance companies.” The concern is that a continued exodus of healthier individuals could lead to a “death spiral,” where only the sickest remain insured, driving costs even higher. However, Cox reassures that “at this point, we don’t see any parts of the country that are at risk of having no insurance company.”
Despite these reassurances, the outlook remains challenging as premiums are expected to rise once more in 2027, according to early rate filings reviewed by Pogue. This ongoing trend may further diminish ACA enrollment as consumers grapple with escalating healthcare costs.
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