Approximately 3 million fewer Americans held Affordable Care Act (ACA) health insurance plans in February compared to the same period last year, according to new federal data. This represents a 13% decrease in enrollment, from 22.1 million people in 2025 to 19.2 million this year.
The U.S. Department of Health and Human Services suggested in a report released Friday that a federal effort to curb fraudulent enrollment might explain the decline. However, health analysts point to the expiration of federal subsidies on January 1 as a more significant factor, which led to a substantial rise in plan costs, making them unaffordable for many.
"We know that real people lost their health insurance coverage," said Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF. Survey findings indicate that this coverage loss coincided with millions of individuals facing "double or even triple digit increases in their premium payments."
The data, compiled in April but reflecting coverage in February, provides the government's initial official assessment of how a lack of affordability impacted enrollment following the expiration of a nonpayment grace period. Earlier federal estimates in January had indicated a drop of about 800,000 fewer sign-ups compared to the previous year, marking the first time in four years that enrollment had decreased at that point in the enrollment window.
KFF anticipates a continued decline in the total number of individuals enrolled in the government healthcare program throughout the year, potentially reaching a low of approximately 17.5 million. This would represent a significant reduction for the ACA, a key federal program offering subsidized health insurance to working-age individuals who do not qualify for Medicaid. In recent years, ACA plans have become a popular option for independent workers, including gig workers, farmers, ranchers, and hairstylists, who lack employer-sponsored health coverage.
The ACA subsidies that expired this year were a point of contention in congressional debates last fall, with bipartisan calls for their renewal. The sharp increases in healthcare costs across ACA and other insurance markets emerge as affordability concerns rank high among voters heading into the November elections.