More than a million people dropped their Affordable Care Act coverage this year after Congress let those enhanced pandemic-era subsidies expire. That number is likely to rise significantly as the year goes on, because many people who did sign up for a plan have not been paying their premiums. For the first time in years, the number of insurers offering ACA plans has dropped, too, according to a new analysis from the health policy nonprofit KFF.After Congress and President Joe Biden approved the enhanced subsidies in 2021, the number of people with ACA insurance more than doubled in just four years.At the same time, “there was a dramatic increase in the number of insurers looking to offer health insurance,” said Vivian Ho, a health economist at Rice University. And that’s because there was a lot of money to be made.But now, with the enhanced subsidies gone, the opposite is happening — people are dropping out and so are insurers.“One would expect in any market, if there's not as much profit to be made, there's going to be fewer suppliers of the service,” Ho said. It’s your standard supply and demand.Cynthia Cox, a senior vice president at the health policy nonprofit KFF with a focus on the Affordable Care Act, said the issue for companies like Aetna, which pulled out this year, and Cigna, which is leaving next year, isn’t just the number of people dropping plans.“Insurers are also concerned that it's healthier people who are disproportionately dropping that coverage,” Cox said. After all, sicker people are more expensive to insure.There are still plenty of companies offering marketplace plans.“Right now, I think most people are still going to have enough choice of insurers as long as we don't see a lot of further exits,” Cox said. “But there might be more parts of the country that do only have one insurer or two insurers to choose from.”Cox added that less competition could mean higher premiums.From May 2026: Nearly 5 million people could drop ACA coverage this year, pushing premiums even higherFrom March 2026: Survey shows 9% of ACA enrollees uninsured after subsidies expiredFrom October 2025: Here's what the end of ACA subsidies could mean for your health insurance