ACA Marketplace Enrollment Falls 13 Percent in 2026 as Enhanced Subsidies Expire and Initial Sign-ups Drop One Million

The Department of Health and Human Services released data on June 26 showing that five million people who signed up for 2026 Affordable Care Act coverage in the 29 states using Healthcare.gov either disenrolled or failed to pay premiums. Enrollment for 2026 fell 13 percent from 2025 levels. Initial sign-ups were already one million lower than the prior year.

Premiums doubled on average after enhanced premium tax credits expired when Republican lawmakers declined to extend them. Democrats had shut down the federal government in October 2025 in an unsuccessful effort to keep the credits in place. Cynthia Cox, director of KFF's Program on the ACA, said the main takeaway is that enrollment is down 13 percent from last year.

She added that coverage losses occurred at the same time millions faced double or even triple digit premium increases. The Paragon Health Institute has advanced the theory that prior enrollment growth stemmed from fraud. Cox and Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms, said available data do not support attributing the five million person drop to fraud.

Pogue stated there is no evidence that a drop of this size can be explained by fraud allegations and pointed instead to decisions based on monthly affordability. Cigna announced it will not participate in ACA markets in 2027. Early insurance rate filings for 2027 indicate premiums will rise again, according to an analysis by Pogue.