5 Million Have Dropped ACA Insurance After Trump and the GOP Let Prices Skyrocket
5 million have dropped ACA insurance – With the release of new data on Friday, it has become clear that more individuals than anticipated have left the Affordable Care Act (ACA) health insurance market for 2026. The statistics reveal a significant decline in enrollment, raising questions about the long-term viability of the program under current policy conditions.
According to the Department of Health and Human Services, the number of people enrolled in ACA marketplace plans has decreased by five million compared to the previous year’s peak. This drop is attributed to a combination of factors, including a 1 million reduction in new sign-ups and an additional 4 million individuals who either voluntarily canceled their plans or failed to pay premiums, resulting in coverage loss. The surge in premium costs, which rose sharply after the Trump administration and Republican lawmakers allowed enhanced tax credits to expire, has played a critical role in this trend.
Health policy analysts had anticipated this decline earlier this year, based on initial enrollment numbers that lagged behind the prior year. As the months progressed, they predicted that the situation would worsen as consumers grappled with the financial burden of increased premiums. The data now supports these projections, highlighting a 13% drop in enrollment from 2025.
While the Trump administration has attributed the decline to efforts to combat fraud, many experts argue that this is not the primary cause. Cynthia Cox, director of the KFF Program on the ACA, explains that the reduction in coverage occurred simultaneously with widespread premium hikes. “The main takeaway is that enrollment is down 13% from last year,” she notes. “Though the administration cites fraud as a reason, this coverage loss happened at the same time millions of people faced steep increases in their premium payments due to the expiration of enhanced tax credits.”
“The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people,” Cox adds.
The theory that fraud drove the enrollment drop was initially proposed by the Paragon Health Institute, a conservative think tank with strong ties to the Trump administration. However, this perspective has faced scrutiny from health policy experts who question its validity. They argue that the pandemic-era enrollment growth was a direct result of Congress allocating billions in federal funds to subsidize premiums through enhanced tax credits. This made ACA plans more accessible and attractive to a broader population.
Cox emphasizes that while fraud is a known issue in the ACA marketplaces, it does not fully account for the 5 million decline. “Fraud is a real problem in all insurance markets, but it’s not the sole reason for this trend,” she says. The primary driver, she suggests, is the financial strain on consumers as premium costs doubled on average from 2025 to 2026.
The decision to let enhanced tax credits expire has placed additional pressure on households already struggling with inflation. As premium costs climbed, individuals were forced to make difficult choices about how to allocate their budgets, whether to work additional hours, or how to manage family expenses. This economic context has amplified the impact of the policy change, leading to a notable shift in consumer behavior.
Insurance companies have also felt the consequences of this decline. Several, including Cigna, have announced their intention to withdraw from ACA markets in 2027. Cox explains that fewer customers mean a less attractive market for insurers, who may seek alternative avenues for growth. “If there are fewer customers, then that makes the market less appealing to insurance companies,” she says.
Another concern is the risk of a “death spiral” in the ACA marketplaces. This phenomenon occurs when healthier individuals, who typically pay lower premiums, leave the market, leaving behind a higher proportion of sicker enrollees. As a result, insurance companies may face higher costs, leading to even greater premium increases. Cox acknowledges this risk but remains optimistic. “At this point, we don’t see any parts of the country that are at risk of having no insurance company,” she says. “If that were to happen, that would be what a death spiral might look like.”
Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, agrees with Cox’s assessment. “I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud,” she states. “There’s lots of evidence pointing to people making decisions based on what they can pay each month.”
Looking ahead, the trend of rising premiums shows no signs of slowing. Early rate filings for 2027 indicate that costs will continue to increase, potentially compounding the challenges faced by consumers. Meanwhile, enrollment numbers may shrink further, though experts believe the market will remain stable for now.
Despite the current challenges, the ACA is still a vital part of the healthcare landscape for millions. The decline in enrollment underscores the importance of policy decisions that affect affordability, but it also highlights the resilience of the program. As the market adjusts to new realities, the focus remains on how to sustain coverage without exacerbating financial burdens on families.
For now, the data suggests that the ACA marketplaces are navigating a difficult transition. While the administration’s narrative about fraud has gained traction, the broader economic context and policy changes provide a more comprehensive explanation for the enrollment drop. The coming months will be crucial in determining whether the market can stabilize or if the losses will continue to mount, reshaping the healthcare landscape for future enrollees.
