5 million people who had signed up for Affordable Care Act marketplace coverage this year have dropped their insurance, the Department of Health and Human Services reported Friday, confirming the grim predictions health policy analysts made months ago. The data from the 29 states that use the federal Healthcare.gov platform shows that enrollment fell by 13% compared with 2025, as premiums doubled after the expiration of pandemic-era subsidies that had made coverage affordable for millions.
“The main takeaway is that enrollment is down 13% from last year,” said 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 HHS report covers the period after initial sign-ups in January had already shown roughly 1 million fewer plan selections. Experts predicted the final tally would be worse as enrollees faced monthly premium bills. The enhanced premium tax credits, which had helped lower-income enrollees afford coverage, lapsed at the end of 2025 after Republican lawmakers declined to extend them and a Democratic-led government shutdown in October failed to produce a deal.
The Trump administration has argued that the enrollment surge during the pandemic was fueled by widespread fraud — a theory promoted by the Paragon Health Institute, a conservative think tank influential in the administration. The administration has pointed to its anti-fraud efforts as a reason for the drop. But Cox and other researchers say the evidence points in a different direction.
“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,” Cox said. “When their costs went up, many of them dropped their coverage.”
Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, echoed that assessment.
“I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud,” Pogue said. “There’s lots of evidence pointing to people making decisions based on what they can pay each month.”
The coverage loss is creating a secondary problem: the people dropping plans tend to be healthier, leaving a smaller and sicker risk pool. Several insurers, including Cigna, have announced they will not participate in ACA marketplaces next year, raising concerns about competition and consumer choice. Cox said she is not yet worried about a full “death spiral” — in which rising premiums drive out healthy enrollees until the market collapses — but acknowledged that the trend bears watching.
“I think there are still enough people buying ACA marketplace coverage and that’s going to keep these markets working,” Cox said. “At this point, we don’t see any parts of the country that are at risk of having no insurance company. If that were to happen, that would be what a death spiral might look like.”
Looking ahead, early insurance rate filings for 2027 show premiums are on track to rise again, according to a recent analysis by Pogue at Georgetown. The combination of higher costs and a shrinking customer base could continue to pummel consumers already navigating elevated health care costs and persistent inflation.