5 million have dropped ACA insurance after Trump and the GOP let prices skyrocket
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Far more people than previously known have dropped Affordable Care Act health insurance for 2026, according to data released Friday.
Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high reached last year. More than 1 million fewer people picked a plan for 2026, and then 4 million more either disenrolled or failed to pay their premiums and therefore dropped coverage. Prices in the market skyrocketed after President Trump and Republicans in Congress failed to extend extra financial help for enrollees last year. The Department of Health and Human Services published a report about
Details
The 5 million reflects what insurers, administrators, and other health policy experts expected earlier this year. After initial sign ups were lower than last year, they predicted that the picture would get worse as time went on and people found they could not afford to pay their premiums.
“The main takeaway is that enrollment is down 13% from last year,” explains Cynthia Cox, director of KFF’s Program on the ACA. “While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments with the expiration of enhanced tax credits.”
The idea that the growth in enrollment was due to massive fraud is a theory advanced by the Paragon Health Institute, a conservative think tank that’s influential in the Trump administration.
Analysis
Many health policy experts are skeptical. They say the increase in enrollment during the pandemic is not suspicious. It was a predictable consequence of Congress’s investment of billions of federal dollars in making premiums more affordable — the enhanced premium tax credits.
“The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people,” adds Cox.
This year’s drop in enrollment is also predictable, given that premium costs doubled, on average, from 2025 to 2026. The costs went up after Republican lawmakers let the enhanced premium tax credits expire; Democrats shut down the government in October 2025 trying to negotiate an extension of the credits that would have kept prices low.
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