More than 5 million Americans have dropped their Affordable Care Act (ACA) or Obamacare health insurance plans after enhanced federal subsidies expired, causing premium costs to rise sharply and reigniting the political battle over the health care law signed by former President Barack Obama.New data released Friday by the U.S. Department of Health and Human Services (HHS) show that 19.2 million people will still be enrolled in ACA marketplace plans in 2026. That number is down from a record high of 24.2 million in 2025, with more than 1 million fewer people choosing plans during the open enrollment period and another 4 million subsequently dropping coverage or failing to pay premiums.Prices fell sharply after an enhanced premium tax credit expired after President Donald Trump and congressional Republicans refused to extend subsidies introduced by the Biden administration during the Covid-19 pandemic. Democrats had sought to preserve financial aid and even shut down the federal government during negotiations to extend the program in October 2025.The Affordable Care Act (named for former President Barack Obama) significantly expanded health insurance coverage after its passage in 2010. Supporters say the temporary increase in subsidies keeps health insurance affordable for millions of people, while Republicans and the Trump administration argue the program is vulnerable to fraud and improper enrollment.Enrollment currently stands at 19.2 million, according to HHS. The department’s report also highlighted concerns about fraud and improper registrations, saying the Trump administration was working to reduce such cases.However, some health policy experts attribute the decline primarily to soaring insurance costs, rather than fraud.“The main takeaway is that enrollment is down 13 percent from last year,” explained Cynthia Cox, director of KFF’s ACA program. “While the Trump administration attributes enrollment declines to their attempts to address fraud, this loss in coverage occurs at a time when millions of people face double- and even triple-digit increases in premiums as enhanced tax credits expire.”Health policy experts say enrollment surges between 2021 and 2025 as increased subsidies sharply lower premium costs.“During periods when subsidies increase, the market doubles in size because insurance coverage is cheaper and more attractive to people,” Cox said.After the enhanced tax credit expires, average premium costs roughly double between 2025 and 2026, prompting many consumers to leave the market.“When their costs went up, many of them dropped their insurance,” Cox said.The Trump administration cited arguments made by the conservative Paragon Health Institute that pointed to fraud as a major reason for an earlier surge in Obamacare enrollment. However, many independent health care experts dispute this interpretation.“I’ve seen no data that suggests the conclusion that the 5 million decline can be explained by fraud allegations,” said Stacey Pogue, senior fellow at the Georgetown Center for Health Insurance Reform. “There’s a lot of evidence that people are making decisions based on what they can afford each month.”Experts say rising premiums are also creating challenges for insurance companies. Several companies, including Cigna, have announced plans to exit the ACA market in some areas, raising concerns about reduced competition and higher prices.“If there are fewer customers, then the market becomes less attractive to insurance companies,” Cox said.Healthy people are more likely to drop coverage, which could weaken the insurance market over time, she said. However, she does not believe the market is currently at risk of entering a so-called “death spiral.”“I think there are still enough people buying ACA marketplace coverage that it will keep those marketplaces functioning,” she said. “Currently, we don’t see any area of the country at risk of being uninsured. If that happens, that’s what a death spiral will look like.”Early insurance filings for 2027 show premiums could rise again next year, suggesting enrollment may continue to decline unless Congress reconsiders financial aid to ACA policyholders.The issue is expected to be a major health care debate ahead of the November midterm elections, with Democrats accusing Republicans and the Trump administration of allowing subsidies to lapse while the administration insists a crackdown on fraud is improving the integrity of the Obamacare marketplace.
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