Millions of Americans who buy their own health insurance coverage through the Affordable Care Act marketplaces faced a stark choice this year: pay more than twice as much to keep the same plan or go without. Many did not keep their coverage.
Federal data released on June 26, 2026, shows that marketplace enrollment fell from 21.8 million people in February 2025 to 19.2 million in February 2026, a decline of about 2.6 million people, or 12%. That is the steepest single-year decline since the marketplaces opened in 2014. ACA marketplaces (or exchanges) are government-regulated platforms where individuals and small businesses can shop for and purchase compliant private health insurance.
As a health economist who studies how insurance coverage affects people’s health, I see the drop as more than a numbers story. The key question is: What happens to people’s health when coverage becomes too expensive to keep?
Why enrollment fell
The drop in enrollment numbers traces back largely to the expiration of the ACA’s enhanced premium tax credits, which lowered enrollees’ monthly payments when they were in effect from 2021 through 2025.
