Obamacare enrollment drops roughly 1.3 million as premium subsidies expire

Millions Face Doubled Health Insurance Costs

For the first time since 2020, fewer Americans signed up for Affordable Care Act health insurance.

About 23.0 million people enrolled for 2026 coverage, down from 24.3 million the year before, according to the latest data from the Centers for Medicare & Medicaid Services.

The culprit is the expiration of enhanced premium tax credits that had kept costs low since 2021. Without them, the average subsidized enrollee will see their annual premiums more than double.

The political fallout could reshape the 2026 midterm elections, especially in red states where enrollment had tripled.

Premiums Jump From $888 to $1,904

The numbers are brutal for millions of families. Under the enhanced subsidies, the average ACA enrollee paid about $888 per year for a benchmark Silver plan.

In 2026, that same coverage will cost around $1,904—a 114% increase, according to KFF.

For a 40-year-old earning $50,000 annually, that translates to roughly $2,000 more per year.

Older adults face even steeper hikes because premiums rise with age. Many enrollees who had $0 monthly premiums will now owe hundreds of dollars.

COVID Relief Created These Subsidies

The enhanced tax credits started in March 2021 as part of the American Rescue Plan Act, pandemic relief legislation.

President Biden signed the law on March 11, 2021, to help Americans struggling with pandemic-related job losses and income drops.

The credits did two big things. They made coverage completely free for people earning up to 150% of the federal poverty level. And they capped premiums at 8.5% of household income for everyone else, no matter how much they earned.

Democrats Extended Them Through 2025

When the original credits were set to expire in 2022, Democrats pushed through a three-year extension via the Inflation Reduction Act. That kept the enhanced subsidies running through December 31, 2025.

Republicans opposed making them permanent, citing the cost to the federal budget. The Congressional Budget Office estimated a permanent extension would cost about $350 billion over 10 years.

Democrats argued the spending was worth it to keep millions insured.

Enrollment Doubled in Four Years

The subsidies worked as intended, though other factors contributed.

ACA marketplace enrollment had hovered between 11 and 12 million people from 2015 through 2020. Once the enhanced credits kicked in, signups surged.

By 2025, enrollment hit a record 24.3 million—more than double what it had been four years earlier.

The enrollment growth was also fueled by the end of Medicaid’s continuous enrollment requirement in 2023, which pushed millions onto marketplace plans.

Health policy experts credited the affordability boost with dramatically reducing the number of uninsured Americans.

Trump States Gained the Most

The enrollment surge was concentrated in Republican territory.

About 88% of the growth since 2020 came from states that President Trump won in the 2024 election.

Six states more than tripled their ACA enrollment: Texas grew 255%, Mississippi 242%, West Virginia and Louisiana 234% each, Georgia 227%, and Tennessee 221%.

More than three-quarters of all ACA enrollees now live in states Trump carried.

43-Day Shutdown Changed Nothing

Senate Democrats tried to force Republicans to extend the subsidies by blocking government funding.

The shutdown began on October 1, 2025, and lasted 43 days, making it the longest in American history.

Air traffic controllers worked without pay. Flights were delayed across the country. But when eight Senate Democrats finally voted to reopen the government on November 12, they got only a promise that the Senate would vote on the subsidies later.

That vote happened in December. Both parties’ proposals failed.

Neither Party Could Pass a Fix

Democrats proposed extending the enhanced credits for three more years, which would have added about $85 billion to the deficit but kept millions more people insured. Republicans countered with a plan to redirect subsidy money into health savings accounts.

On December 11, both bills failed in the Senate with identical 51-48 votes. Neither side could get the 60 votes needed to advance.

Four Republicans—Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska—voted for the Democratic plan.

Congress left for holiday recess with no solution, and the subsidies expired on New Year’s Eve.

Trump Officials Blame Fraud Instead

The Trump administration says the enrollment drop is not primarily about expiring subsidies.

Administration officials have pointed to efforts to crack down on fake and improper marketplace enrollments. A Government Accountability Office investigation found that 96% of fictitious applications submitted by investigators were approved, and more than 275,000 complaints about unauthorized enrollments were filed with CMS in 2024.

Republicans argue this proves the system was vulnerable to fraud. However, the GAO identified about 160,000 potentially fraudulent cases in 2024—roughly 1.5% of ACA applications—far fewer than some critics estimated.

Experts Say Millions Will Go Uninsured

The Congressional Budget Office projects that roughly 4 million Americans will lose insurance without the enhanced subsidies.

The Urban Institute estimates 4.8 million will become uninsured, with another 2.5 million shifting to employer or Medicaid coverage.

The Trump administration attributes much of the drop to fraud crackdowns rather than subsidy expiration.

A GAO investigation found the system vulnerable—96% of fictitious test applications were approved. However, the GAO identified about 160,000 cases in 2024, or 1.5% of ACA applications, as potentially fraudulent—far fewer than critics’ estimates of millions.

Analysts remain divided on how much the decline stems from fraud cleanup versus affordability.

Some States Built Their Own Safety Net

A handful of states are stepping in where Congress failed.

California allocated $190 million to replace subsidies for people earning up to 165% of the federal poverty level, though the state projects 400,000 residents could still become uninsured.

Maryland is covering enrollees under 200% of poverty and providing half the subsidy for those up to 400%.

Colorado committed $100 million to stabilize its individual market.

Connecticut put in $70 million.

New Mexico is the only state fully replacing the expired subsidies for 2026.

Most states, especially those with the highest enrollment growth, are doing nothing.

Health Care Looms Over 2026 Midterms

A KFF poll found 78% of Americans, including majorities of Republicans and Trump supporters, wanted Congress to extend the subsidies.

Now those voters will feel premium hikes before they cast ballots in November.

Democrats are betting that anger over health care costs will flip House seats, especially in districts where ACA enrollment exploded.

Republicans are betting voters will blame Obamacare itself.

This article was created with AI assistance and human editing.

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