New Federal Data Show ACA Enrollment Drops By 2.6 Million Nationwide
HHS data released in late June 2026 show about 2.6 million fewer Americans had Affordable Care Act marketplace coverage in February 2026 than in February 2025.[1]
Total ACA exchange enrollment was about 19.2 million in February 2026, down from roughly 21.8 million at the 2025 peak.[1] Ohio and Oklahoma each saw more than a 32 percent drop in enrollment, the steepest percentage declines, while Florida lost about 443,000 enrollees but still has nearly 4 million people in marketplace plans.[1] Program-integrity work removed or blocked about 2.9 million improper or phantom enrollments between 2025 and early 2026, partly contributing to the net drop.[1]
The enhanced premium tax credits enacted in the American Rescue Plan Act of 2021 were extended through December 31, 2025 by the Inflation Reduction Act of 2022. Those credits temporarily removed the 400 percent federal poverty level cap and lowered what households paid toward premiums, driving subsidized enrollment from about 9.2 million in 2020 to roughly 21.8 million by 2025. When the enhanced credits expired on January 1, 2026, many enrollees saw their monthly premiums double or triple and some dropped coverage they could no longer afford.[1]
Some states that ran their own exchanges and replaced federal aid limited losses or added enrollees; New Mexico increased enrollment by roughly 14 percent after fully replacing the expired federal subsidies.[1] States that use the federal Healthcare.gov marketplace experienced larger average enrollment losses than states with their own exchanges.[1] Officials and advocates disagree over causes, with some pointing to stronger fraud controls and program-integrity work and others blaming the subsidy lapse and sharply higher premiums.
The mainstream summary attributes the enrollment drop primarily to the expiration of enhanced premium tax credits and program integrity measures, but it does not fully capture the broader implications of these changes. Analysis from the Urban Institute suggests that the expiration of these subsidies not only caused premiums to rise sharply but also contributed to an estimated 4.8 million additional uninsured individuals in 2026, indicating a significant public health concern that extends beyond the immediate enrollment figures. This perspective highlights a systemic issue of healthcare affordability that the mainstream account glosses over, focusing instead on enrollment numbers without addressing the underlying crisis of coverage instability for middle-income families who relied on these subsidies.
Additionally, while the mainstream summary mentions that some states with their own exchanges fared better, it does not elaborate on the stark contrast in outcomes between states that utilized the federal Healthcare.gov marketplace and those that did not. Reports indicate that states relying on federal exchanges experienced larger average enrollment losses, suggesting that local policy decisions and the ability to adapt to subsidy changes played a crucial role in enrollment outcomes, a nuance that the summary overlooks. This divergence in state performance underscores the complexity of the ACA landscape and the varying impacts of federal policies on state-level healthcare access.[2][3]
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📊 Relevant Data
As of February 2026, total ACA exchange enrollment was approximately 19.2 million people.
ACA Exchange Enrollment in 2026 — ASPE/HHS
Subsidized ACA marketplace enrollment was 9.2 million in 2020 before the enhanced premium tax credits took effect in 2021 and grew to 21.8 million by 2025.
Enhanced Premium Tax Credit and 2026 Exchange Enrollment — Congressional Research Service
Program integrity measures removed or blocked approximately 2.9 million improper or phantom enrollments between 2025 and early 2026, contributing to the observed decline.
ACA Exchange Enrollment in 2026 — ASPE/HHS
📌 Key Facts
- HHS data posted in late June 2026 show about 2.6 million fewer Americans had ACA marketplace coverage in February 2026 compared with February 2025.
- Ohio and Oklahoma each saw more than a 32% drop in ACA enrollment, the sharpest percentage declines among states.
- Florida lost about 443,000 ACA enrollees but still has nearly 4 million people in marketplace plans, more than any other state.
- Enhanced ACA premium tax credits expired on January 1, 2026, causing many enrollees’ monthly premiums to double or triple.
- New Mexico increased ACA enrollment by roughly 14% after fully replacing the expired federal subsidies with state funding through at least mid-2027.
- States using the federal Healthcare.gov marketplace experienced larger average enrollment losses than states with their own exchanges, some of which added new cost offsets.
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