Affordable Care Act marketplace enrollment reached record highs in recent years as federal tax credits lowered monthly premiums for millions of Americans. In 2026, that trend reversed after the enhanced subsidies expired on January 1, pushing many consumers out of Obamacare coverage as costs rose.
Enrollment fell after subsidy expiration
The national rollback is showing up in both sign-up data and paid coverage totals. Reuters reported in January that Obamacare enrollment for 2026 fell to about 23 million plan selections, down by more than 1 million from the prior year, after the expiration of extra pandemic-era subsidies. By late June, the Associated Press reported that effectuated enrollment, meaning people who selected plans and then paid for them, had fallen 13% to 19.2 million from 22.1 million in 2025.
That drop is significant because paid enrollment is the clearest measure of how many people actually kept coverage. The Department of Health and Human Services said part of the decline may reflect a crackdown on fraudulent or “phantom” enrollments, according to the AP. But health policy analysts cited by the AP said the larger driver was affordability, with many households facing premium bills they could no longer sustain once the enhanced tax credits ended.
KFF had warned before the expiration that out-of-pocket premium payments would more than double on average for many marketplace consumers if Congress did not renew the enhanced credits. A separate KFF analysis found insurers were proposing a median 18% rate increase for 2026 on top of the subsidy changes. The Congressional Budget Office had previously estimated that 2.2 million consumers would lose insurance in 2026 if the enhanced ACA subsidies were allowed to expire.
The coverage losses are being felt across states that use both HealthCare.gov and state-based exchanges, but a complete national breakdown is still not public. Early 2026 reporting from federal officials showed fewer sign-ups than the year before, and later paid-enrollment data confirmed that many consumers who initially selected plans did not keep them active through premium payments.
What is confirmed is that the affordability change hit middle-income households especially hard. KFF said consumers above 400% of the federal poverty level lost subsidy eligibility altogether when the enhanced assistance expired, restoring the ACA’s old “subsidy cliff.” That means some families who had qualified for help in 2025 faced the full sticker price of coverage in 2026.
What is not yet known is the full list of states or local markets with the biggest net losses in active coverage. Public reporting has identified New Mexico as an exception because the state used its own funding to offset the loss of enhanced federal tax credits for consumers, according to KFF Health News. Outside of exceptions like that, the state-by-state picture is still developing as insurers, exchanges, and federal agencies release more complete 2026 enrollment data.
The central reason for the decline is the expiration of the enhanced premium tax credits first created in 2021 and later extended through 2025. Those subsidies lowered what many ACA enrollees paid each month and removed the prior income cap that cut off assistance above four times the federal poverty level. Once that aid ended, many consumers saw double-digit and, in some cases, triple-digit premium increases, according to reporting from the AP and analyses from KFF.
Broader insurance pricing trends added pressure. KFF said insurers were seeking the largest 2026 premium increases since 2018, citing rising health care costs along with the subsidy expiration. Pew Research Center also noted in January that millions of marketplace consumers were entering 2026 with higher insurance costs because the temporary subsidy enhancements had ended.
For consumers, the practical effect is straightforward: selecting a marketplace plan no longer guarantees that coverage will remain affordable through the year. Analysts told the AP they expect enrollment to keep falling as some auto-enrolled consumers fail to pay premiums and lose coverage after grace periods. That means the final 2026 Obamacare total may decline further before the year ends, even after open enrollment has closed.