ACA enrollment sinks sharply as coverage costs soar in 2026

Far fewer Americans enrolled in an Affordable Care Act health care plan, new federal data shows, with millions facing higher premiums after tax subsidies under the insurance program expired in December

According to figures from the Centers for Medicare and Medicaid Services (CMS), 22.8 million people have signed up for ACA coverage for 2026 since open enrollment started on Nov. 1. That’s down 1.4 million from the number of Americans who had enrolled in Obamacare, as the health plans are known, a year ago.

Nationally, around 800,000 fewer people have selected plans compared to a similar time last year, marking a 3.5% drop in total enrollment so far. That includes a decrease in both new consumers signing up for ACA plans and existing enrollees re-upping them.

Open ACA enrollment in most states for February coverage ends on Jan. 15.

The drop in enrollment comes as many ACA participants face sharply higher monthly premiums because of a December 31 lapse in tax credits that lowered households’ monthly health plan costs. After months of debate and a 6-week government shutdown, Congress has yet to extend the credits or settle on another remedy.

The House last week approved legislation that could preserve the enhanced subsidies for another three years. The fate of the bill is now in the hands of the Republican-controlled Senate.

Over 20 million Americans received the ACA subsidies last year. Health policy group KFF estimates that they could see their premiums swell by an average of 114%, from around $888 in 2025 to $1,904 this year, unless the tax credits are extended. 

Experts have warned that the end of the subsidies could push more people to dump their coverage in the face of higher premiums and out-of-pocket expenses. The nonpartisan Congressional Budget Office estimates 4 million people will eventually lose their insurance without an extension of the credits.

Robert Kaestner, a health economist at the University of Chicago, said some ACA enrollees who drop the coverage may have other options, such as going on a partner’s employer health plan or changing their income to qualify for Medicaid. Others are likely to go without insurance while they look for alternatives.

“My prediction is 2 million more people will lack health insurance for a while,” Kaestner told the Associated Press. “That’s a serious issue, but Republicans would argue we’re using government money more efficiently, we’re targeting people who really need it and we’re saving $35 billion a year.”