About 3 million fewer Americans had Affordable Care Act health insurance plans in February 2026 compared to the same month last year, according to data released Friday by the Department of Health and Human Services. The 13% decline — from 22.1 million to 19.2 million — followed the expiration of enhanced premium tax credits at the end of 2025 that had capped premium costs for many enrollees.
HHS suggested in its report that the decline could stem in part from a federal crackdown on fraudulent or “phantom” enrollment. Health policy analysts offered a different explanation, pointing to the Jan. 1 expiration of the pandemic-era subsidies that had made coverage more affordable.
“We know that real people lost their health insurance coverage,” said Cynthia Cox, a vice president and director of the ACA program at KFF, the health care research nonprofit. “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments.”
Cox cited KFF survey findings on people who had left their plans as evidence that affordability, not fraud, drove the enrollment drop. The enhanced subsidies had lowered premium costs for more than 20 million Americans, and their expiration left many people unable to afford coverage.