ACA enrollment – More than 3 million people have dropped Affordable Care Act coverage this year as enhanced subsidies expired at the end of 2025, raising premiums and shrinking enrollment. While the Biden administration’s HHS points to crackdowns on improper signups and fraud,
For millions of Americans, the shock of higher premiums didn’t arrive with a headline. It arrived at renewal—month after month—until the monthly payment stopped and coverage ended.
The numbers show the scale of that break. The U.S. Department of Health and Human Services reported that about 19.2 million people were enrolled in an Affordable Care Act plan as of February. That is down from 23.1 million who signed up for coverage by January 2026. In January 2025, 24.2 million had signed up.
The administration says it has also been fighting improper enrollment. But as enhanced ACA subsidies expired at the end of 2025—making insurance more expensive for millions—enrollment began to fall quickly.
HHS said the expiration of the enhanced subsidies contributed to higher costs. and it pointed to efforts to crack down on improper signups. In its report, the department cited suspected improper, phantom, or fraudulent enrollments as a contributor to enrollment growth. It said nearly half of the ACA enrollment growth from 2021 to 2024 was “suspected to be improper, phantom or fraudulent.”.
The department also said Trump administration efforts blocked the enrollment of 2.9 million people who had been “improperly receiving subsidies they did not qualify for.”
Separate from the fight over eligibility, affordability appears to be doing most of the damage. Experts who track ACA enrollment said the drop is consistent with what happens when people face higher costs they can’t absorb.
“When you raise prices for a good or service, fewer people are going to buy it,” Sabrina Corlette, codirector of Georgetown University’s Center on Health Insurance Reforms, said. “That’s what we’re seeing with health care.”
Cynthia Cox. vice president and director of the program on the ACA at KFF. pointed to both forecasted and observed behavior. Private health insurers that sell ACA plans and the nonpartisan Congressional Budget Office have also projected big enrollment drops because consumers would have to pay more to keep their insurance plans. Cox said.
“The enrollment drop ‘really isn’t surprising,’” Cox said, adding that the numbers align with expectations going into this year.
There is also a key distinction in what those enrollment counts mean. Cox said there’s a difference between the number of consumers who sign up for a plan and those who make a monthly payment. which is required to maintain coverage. Coverage for individuals who sign up for an ACA plan is terminated if they fail to make monthly payments.
When comparing “effecuated” enrollment—people who make a monthly payment—enrollment dropped from 22.1 million in 2025 to 19.2 million people in February 2026.
KFF projects enrollment will drop even more as some struggle to make monthly payments while facing other expenses, including housing costs and grocery bills. In a KFF survey, 17% of enrollees said they were not confident they could afford their health insurance premiums for all of 2026.
As the enrollment story shifts from subsidy expiration to next year’s price pressure. Georgetown is already pointing toward another round of rate increases. A Georgetown Center on Health Insurance Reforms report published June 18 suggests that health insurers will probably hike rates again next year.
Georgetown researchers analyzed health insurer filings in nine states and Washington, DC. Insurers in those states sought rate increases for 2027 coverage ranging from 6.5% in Vermont to 22.4% in Washington state. Filings for the federal marketplace—which covers most Americans—aren’t due until mid-July.
HHS says fraud remains a real problem. and it is using that rationale to explain how its system is being cleaned up. The department said Trump administration efforts prevented 1.5 million enrollees from getting subsidies they did not qualify for and ended or blocked an additional 1.4 million enrollees.
HHS estimated that 2.6 million “improper and phantom enrollments” might still be in place, including signups without a Social Security number. The report did not provide further details or evidence on those figures.
The government’s fraud concerns are reflected in complaint activity as well. In a document submitted to the Federal Register. the Centers for Medicare & Medicaid Services said it fielded nearly 342. 000 complaints in 2025 involving “unauthorized enrollment”—cases in which a broker enrolled a consumer in an ACA plan without their consent.
The tension inside all of this is that two forces are moving at once: a government effort to curb improper subsidies, and a market reality in which premiums rose after enhanced subsidies expired. In the middle of that collision, the result is visible in enrollment counts.
Corlette, while acknowledging that affordability drives most of the decline, said the consequences look stark for people trying to stay insured.
“The numbers are bad,” Corlette said. “It doesn’t look good when millions of people are unable to afford health insurance.”
Affordable Care Act ACA enrollment enhanced subsidies expired premiums KFF Georgetown HHS CMS fraud unauthorized enrollment 2027 rate increases