Over 1 million Americans dropped Obamacare this year after subsidies ran out

Enrollment falls after subsidies expire

About 23 million Americans signed up for health insurance through the Affordable Care Act marketplace for 2026.

That is down from a record 24.3 million in 2025, a roughly 5 percent decline and the first drop since the pandemic.

The decline came after Congress failed to renew enhanced premium tax credits that expired on Dec. 31, 2025. Even with the dip, this year’s total is the second-highest in marketplace history.

Enhanced credits began as pandemic relief

Congress created the enhanced premium tax credits in 2021 as part of pandemic relief legislation called the American Rescue Plan. The Inflation Reduction Act of 2022 extended them through the end of 2025.

The credits expanded who could qualify for financial help and boosted the amount of aid for people already eligible. About 92 percent of marketplace enrollees, roughly 22 million people, received these credits in 2025.

Since the credits began, marketplace enrollment more than doubled from about 11.4 million in 2020.

Premiums more than doubled for many

The numbers hit hard. KFF, a nonpartisan health research group, estimates the average subsidized enrollee’s annual premium payments jumped from $888 to $1,904, a 114 percent increase for those keeping the same plan.

A 60-year-old couple earning about $85,000 a year could face annual premiums above $22,000. People earning above 400 percent of the federal poverty level lost eligibility for any tax credit at all.

Basic credits still exist but cover fewer people.

Bronze plan signups surged nationwide

Faced with higher costs, many enrollees downgraded to bronze-tier plans, the cheapest option with the highest out-of-pocket costs.

In California, more than a third of new enrollees chose bronze plans, up from about one in five the year before. In Rhode Island, bronze selections among new enrollees jumped from 15 percent to 38 percent in two years.

Nearly three-quarters of California customers who switched tiers moved to bronze. The average individual deductible for a bronze plan in 2026 is roughly $7,500.

Multiple states saw sharp coverage losses

The losses spread across the country. In Idaho, Massachusetts, and Virginia, roughly twice as many people dropped coverage compared to the same point the prior year.

Pennsylvania saw terminations more than triple to above 70,000. In Maine, total enrollment fell 9.5 percent and new customer signups dropped 24 percent.

Minnesota saw an 8.1 percent enrollment decline and a 50 percent increase in cancellations. State officials in Idaho said three times as many people cited affordability as their reason for leaving.

Consumers said they can’t afford coverage

State exchange officials heard directly from consumers who said they could not make the numbers work.

In New Jersey, the share of enrollees paying $10 or less per month fell from 48 percent to just 8 percent, while the share paying $100 or more jumped 82 percent.

One Indiana couple saw their annual insurance costs rise from about $9,100 to $23,400. Experts say some who signed up may never pay their first premium and could lose coverage in the coming months.

House passed a three-year extension

On Jan. 8, 2026, the House voted 230 to 196 to extend the enhanced subsidies for three more years. Seventeen Republicans crossed party lines to vote with Democrats.

The vote came after a rare discharge petition forced the bill to the floor over leadership objections.

The Congressional Budget Office estimated the bill would cost about $80.6 billion over a decade and projected it would result in 4 million more insured Americans by 2028.

Senate negotiations collapsed in February

A bipartisan group of senators tried to craft a compromise that included a two-year extension with income caps and a $5 monthly minimum payment.

By early February, Republican Sen. Bernie Moreno said the talks were “effectively over.” Senate Majority Leader John Thune said there was no appetite for an extension in the Senate.

President Donald Trump called the enhanced subsidies a flagrant scam and threatened to veto any extension.

Abortion language sank the deal

Democrats and Republicans gave different reasons for the failure.

Democratic negotiators said proposed restrictions on federal funding for abortion services killed the deal. Republicans wanted stricter language tied to the Hyde Amendment, which limits federal spending on abortion.

Democrats argued the ACA already contains Hyde protections and no new language was needed. The two sides could not close the gap despite weeks of meetings.

Analysts warn the worst may come later

Health policy analysts say the initial signup numbers may overstate how many people will actually keep coverage. Many enrollees were automatically renewed and may drop out once they see their bills.

The full picture of who paid their premiums is not expected until summer 2026. The Urban Institute estimates about 4.8 million more Americans could become uninsured this year.

Some experts worry that if younger, healthier people leave the marketplace, premiums could rise further for everyone else.

A few states stepped in with funds

Not every state sat on the sidelines. New Mexico used state funds to fully replace the lost federal subsidies for all enrollees and saw a 14 percent enrollment increase.

California, Colorado, Maryland, and Washington used state money to help some of their enrollees.

Maryland backfilled a portion of lost credits for people earning up to 400 percent of poverty and saw enrollment rise 3.4 percent. Most states, however, have not created programs to offset the losses.

Consumer advocates say the patchwork approach leaves most Americans without a safety net.

Health care costs loom over 2026 elections

Congress could still attach a subsidy extension to a spending bill or reconciliation package later this year. A KFF poll found 67 percent of Americans believe Congress was wrong not to extend the credits.

Health care costs ranked as the top affordability concern among Americans surveyed, above groceries and utilities.

With all House seats and 33 Senate seats up in 2026, health care costs could become a central campaign issue.

For now, Americans who missed open enrollment have limited options unless they qualify for a special enrollment period through a life event.

This article was created with AI assistance and human editing.

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