First Look at ACA Enrollment Numbers After Subsidy Expirations Shows Significant Coverage Losses

Late last month, the federal government released the first set of data showing enrollment in Affordable Care Act (ACA) plans since the enhanced premium subsidies were allowed to expire at the end of last year. The results—which capture the difference between effectuated enrollment (people who signed up and have paid premiums so the coverage is in effect) in February of 2026 compared to February 2025—show dramatic decreases in most states, with 2.6 million fewer Americans covered by an ACA plan across the country.

Cost Is the Most Likely Driver of Change

Although the report suggests that the drop in coverage could be the result of changes that limit “phantom” or fraudulent enrollments, state-specific data points to cost, and specifically premium costs, as the primary driver of the change. In Oklahoma, one of the states with the largest percentage change in coverage, a deputy insurance commissioner told the Associated Press that “[i]t’s all about affordability at this point in time,” in his state, though he cited a crackdown on fraud as a possible driver elsewhere.

Also pointing to cost being the most significant driver of enrollment change is the one state that saw ACA enrollment increase from 2025 to 2026. New Mexico, the only state to fully replace lost federal subsidies out of its own coffers, saw a 14% increase in enrollment. This change was directly attributed to the state’s commitment to reducing premium costs by their Health Care Authority’s Public Relations Coordinator, who said “In New Mexico, we believe health insurance should protect people against medical debt, not cause it.”

Changes Consistent With Expectations

Speaking to the AP after reviewing the data set, Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, said “This is the first time we’ve seen state-level data that shows how much…enrollment truly fell…It’s in line with our expectations, but it does show a very steep drop in the number of people with ACA coverage.”

The expiration of the subsidies and the expected impact of that change on insurance coverage was the subject of significant attention and congressional debate at the end of last year, when the Democratic caucus and some Republicans argued for their extension, but were outvoted by the Republican majority. The impact of that decision on families this year is, as we see in this data set, still being felt.

And things are only going to get worse without action. More consumers are likely to fall away from coverage through the rest of the year, and KFF flags that ACA plans are projecting double-digit rate increases for 2027.

Coverage Losses Increase Risk

As more people lose their coverage, they may delay or skip treatment, which ultimately raises costs for everyone, including health systems, the general economy, and taxpayers. Medicare Rights will continue to urge policymakers to support high-quality, affordable health coverage, and to take steps to improve access to ACA plans, Medicaid, and Medicare Savings Programs that help people get the care they need.

See the ACA enrollment data here.