New federal data shows that approximately 3 million fewer Americans were enrolled in Affordable Care Act health insurance plans this past February compared to the same month in 2025.
The U.S. Department of Health and Human Services released the report on Friday, noting that enrollment fell 13% — dropping from 22.1 million people in 2025 down to 19.2 million this year. The agency suggested the decline may be tied to a federal crackdown on fraudulent or so-called “phantom” enrollments. However, health policy analysts believe the more likely cause is the January 1st expiration of federal subsidies, which triggered steep premium increases that many enrollees simply could not afford.
Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, said the impact on real people is undeniable. “We know that real people lost their health insurance coverage,” she said, pointing to survey data from people who had dropped their plans. “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments.”
The newly released figures were compiled in April but reflect coverage as of February — making this the federal government’s first official snapshot of how unpaid first-of-the-year bills affected total plan enrollment, following the close of a nonpayment grace period.
An earlier federal estimate from January had already shown about 800,000 fewer sign-ups compared to the prior year, marking the first enrollment decline in four years during that stage of the open enrollment window.
Cox said KFF anticipates enrollment will keep sliding throughout the year, potentially bottoming out at around 17.5 million people. That would represent a significant setback for the government’s primary subsidized health insurance program for working-age adults who don’t qualify for Medicaid. In recent years, ACA plans have become a go-to option for gig workers, farmers, ranchers, hairstylists, and others who don’t receive health benefits through an employer.
The subsidies that lapsed this year had been at the heart of a contentious congressional debate last fall, with Democrats and a number of Republicans pushing for their extension. The rising cost of health coverage — across ACA and other insurance programs — is emerging as a major issue heading into the November elections, with voters consistently ranking affordability among their biggest concerns.
