Enrollment in Affordable Care Act marketplace health plans experienced a significant decline of approximately 3 million individuals, or 13 percent, reaching 19.2 million in February 2026 compared to 22.1 million at the end of 2025. This marked the first enrollment decrease since the initial Trump administration and represented the largest drop since ACA marketplaces were established in 2014. The data release provided the first assessment of actual enrollment figures following the expiration of enhanced premium subsidies at the conclusion of 2025.
The Trump administration attributed the enrollment decline primarily to its enforcement efforts targeting fraudulent coverage. The Department of Health and Human Services reported that administrative actions, including the cancellation of coverage for 250,000 individuals enrolled without their consent, had unwound fraudulent enrollment that the agency estimated peaked at 5.6 million people in 2025. Officials characterized these efforts as part of a comprehensive strategy to ensure federal subsidies reached only eligible beneficiaries.
Health policy experts and researchers, however, disagreed with this characterization. According to academic analysts and think tank scholars, the enrollment decline most likely resulted from substantially higher insurance premiums following the lapse of enhanced subsidies. Estimates indicated enrollees faced average premium increases of 114 percent, rising to $1,904 in 2026 from $888 in 2025. Some individuals confronted premium increases exceeding $20,000 annually, making coverage unaffordable for many lower-income households.
Experts questioned whether problematic enrollment categories definitively indicated fraud. They noted that lawfully present immigrants without Social Security numbers represented legitimate coverage scenarios, and income misstatements could reflect estimation errors rather than intentional deception. Some analysts suggested the administration’s fraud narrative provided political cover during a midterm election year when healthcare affordability remained a primary concern among Americans.
Projections indicated the enrollment decline would likely persist throughout 2026 and beyond. The Congressional Budget Office estimated total ACA marketplace enrollment could fall to 12.5 million by 2028, while the uninsured population share was projected to increase from 7.6 percent in 2025 to 10.4 percent by decade’s end.
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