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.
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.
