Texas Children’s Hospital’s Kangaroo Crew members walk through the hallways during a simulation at the hospital in Houston on Sept. 23, 2025.
About 22.8 million Americans have so far signed up for 2026 health insurance via the Affordable Care Act marketplace, according to data issued Monday by the Centers for Medicare & Medicaid Services. That’s a decline of about 1.5 million from the 24.3 million people who had enrolled in health care coverage for 2025.
The data amount to an early sign of the fallout from the recent lapse of enhanced premium subsidies that the federal government had offered since 2021.
Now, health experts expect millions of people to drop their coverage amid soaring health premiums — an issue that may threaten Republican success in this year’s congressional midterms, since most ACA enrollment growth in recent years has occurred in red states, data shows.
Impact of Lapsed Subsidies
Without the enhanced subsidies, which expired at the end of 2025, the average recipient will see their premiums more than double this year, according to KFF, a health policy research group.
Health experts credited the enhanced ACA subsidies, which made insurance more affordable for consumers, with greatly reducing the number of uninsured Americans since taking effect. Total ACA enrollment had hovered around 11 million to 12 million from 2015 to 2021, but doubled to more than 24 million by 2025, once the enhanced subsidies were in force.
Now, coverage is poised to become a greater focus as millions of Americans are expected to drop insurance altogether amid high costs.
Expected Decline in Coverage
“The health policy debate in recent years really has been predominantly about costs, as the coverage challenge had largely been resolved,” said Jonathan Burks, executive vice president for economic and health policy at the Bipartisan Policy Center. “Expiration of the enhanced subsidies has reopened that coverage debate.”
The CMS data doesn’t yet paint a complete picture of enrollment for 2026. Health experts expect more households to drop their coverage in the coming months.
For one, the figures don’t yet encompass the whole open-enrollment period, which runs through Jan. 15. The most recent CMS enrollment data was current as of Jan. 3 for states using the federal Healthcare.gov platform and Dec. 27 for state-based ACA exchanges. People still have time to decide if they will sign up or not.
Political Implications
The expired subsidies are also shaping up to be a key political issue as congressional midterm elections loom at year’s end and at a time when affordability is top of mind for households.
Overall ACA enrollment has more than doubled since 2020, from roughly 11 million to a record-high 24 million in 2025, according to a KFF analysis of federal data.
Most of that enrollment boost came in states that President Donald Trump won in the 2024 election.
About 88% of the total growth in the ACA marketplace since 2020 — 11.4 million out of 12.9 million new enrollees — is from such states, according to KFF.
Read more about the impact of the lapsed subsidies Here
Smart Tip for Readers
When exploring health insurance options, consider consulting with a licensed insurance broker or agent to navigate the complexities of the Affordable Care Act marketplace and find a plan that suits your needs and budget. Additionally, be sure to review and understand the terms of your policy, including deductibles, copays, and coverage limits, to avoid unexpected medical bills.
