Five million people who signed up for Affordable Care Act health plans for 2026 have since dropped coverage by either disenrolling or failing to pay premiums. The drop follows sharp premium increases after enhanced federal subsidies expired.
The federal government released data Friday showing the scale of the decline in the 29 states that use the HealthCare.gov marketplace. Enrollment fell 13 percent from the prior year.
Cynthia Cox, director of KFF's Program on the ACA, said the main driver was higher costs after Congress allowed enhanced premium tax credits to lapse. She noted that average premiums roughly doubled from 2025 to 2026.
Cox and Georgetown Center on Health Insurance Reforms senior research fellow Stacey Pogue said available evidence points to affordability concerns rather than fraud as the primary cause. Pogue added that she saw no data supporting claims that fraud alone explains the five-million-person drop.
Several insurers, including Cigna, have said they will exit some ACA markets next year. Cox said markets are not yet at risk of a death spiral, though early rate filings suggest premiums will rise again in 2027.