ACA marketplace enrollment falls 3 million as subsidies expire

ACA marketplace enrollment fell to 19.2 million in February, about 3 million fewer than a year earlier, as expiring federal subsidies drove up premiums and pushed some families out of coverage. The Health and Human Services estimate marked a 13% drop from 22.1 million in 2025 and came after enhanced premium tax credits expired on January 1.

ASPE counted about 1.5 million enrollees who did not qualify for subsidies and ended or blocked another 1.4 million through February, for a total of 2.9 million. KFF’s Cynthia Cox: people really did lose coverage, and many were hit with premium increases that were “double or even triple digit.”

Lower-income shoppers above the subsidy cliff and working-age people without employer insurance were hit hardest. KFF estimated that a 27-year-old making $35,000 would pay $2,615 a year without the enhanced credits, up from $1,033 with them, while people who had been paying $0 for benchmark plans in some low-income brackets now owe premiums again. Nearly half of adult individual-market enrollees are small business owners, employees or self-employed, and more than 90% buy coverage through ACA marketplaces, where 93% receive a tax credit.

CMS tracked 23.1 million people who selected or were automatically re-enrolled for 2026, including 3.4 million new consumers and 19.6 million returning consumers. The February tally reflected paid-up enrollment after the grace period, not just signups. KFF projects marketplace enrollment could fall further, to about 17.5 million in 2026 and possibly 16.5 million, as insurers raise ACA marketplace premiums by about 20% on average, with a median requested increase of 18%, the largest since 2018. The enhanced credits were created in the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act; a Congressional Budget Office estimate released Sept. 18, 2025 put making them permanent at raising federal deficits by $350 billion from 2026 to 2035 and increasing the number of insured people by 3.8 million in 2035.