About 3 million fewer Americans were enrolled in Affordable Care Act (ACA) health insurance plans in February compared with the same period a year earlier, according to new data released Friday by the U.S. Department of Health and Human Services (HHS). The figures highlight the first major enrollment decline following the expiration of enhanced federal premium subsidies at the start of the year.

The HHS report found ACA marketplace enrollment fell 13%, from 22.1 million people in February 2025 to 19.2 million in February 2026. The department said the decrease may have been influenced by federal efforts to eliminate fraudulent or “phantom” enrollments from the marketplace.

However, health policy experts argue that rising insurance costs after the expiration of federal subsidies played a much larger role in reducing coverage.

Higher Premiums Linked to Enrollment Decline

According to Cynthia Cox, vice president and director of the ACA program at healthcare research nonprofit KFF, millions of consumers experienced substantial premium increases after the enhanced subsidies ended on Jan. 1.

Cox said survey findings indicate that many individuals who left ACA plans did so because they could no longer afford their monthly insurance payments.

She noted that many households faced premium increases reaching double- or even triple-digit percentages, making continued coverage financially difficult for many families.

The latest federal data provide one of the clearest pictures yet of the impact because they reflect enrollment after the marketplace’s grace period for unpaid premiums had expired.

Government Data Reflects Post-Payment Enrollment

The enrollment figures, compiled in April but measuring coverage during February, capture individuals who successfully maintained their health insurance after paying their first premiums of the year.

Earlier government estimates released in January had already indicated weakening enrollment trends. At that time, approximately 800,000 fewer people had signed up for ACA coverage than during the same enrollment period a year earlier, marking the first annual decline in marketplace enrollment in four years.

The February data suggest that additional policyholders lost coverage after failing to keep up with higher premium payments.

More Enrollment Losses Could Follow

KFF expects enrollment to continue declining throughout 2026.

According to Cox, total ACA marketplace enrollment could fall to roughly 17.5 million people before the end of the year if current trends continue.

The Affordable Care Act marketplace has become an increasingly important source of health insurance for working-age Americans who do not receive employer-sponsored coverage and do not qualify for Medicaid.

Those relying on ACA plans include self-employed workers, gig economy employees, farmers, ranchers, hairstylists, freelancers, and other individuals purchasing insurance independently.

Subsidy Expiration Became a Political Issue

The enhanced ACA subsidies that expired this year were the subject of significant debate in Congress last fall.

Democrats and some Republicans supported extending the financial assistance, arguing it would help keep health insurance affordable for millions of Americans.

The expiration comes as healthcare affordability remains a prominent issue for voters ahead of the November elections. Rising medical costs and insurance premiums continue to rank among the public’s leading economic concerns alongside broader cost-of-living pressures.

While federal officials point to anti-fraud efforts as one factor behind lower enrollment, healthcare analysts say the higher premiums following the end of enhanced subsidies appear to have had a substantial impact on the number of Americans maintaining Affordable Care Act coverage.

Tags: Affordable Care Act, Obamacare, Health Insurance, Department of Health and Human Services, Healthcare Policy, Health Insurance Premiums, Congress, Medicaid, Health Coverage, Federal Subsidies

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