Millions Disenroll from ACA as Subsidies Expire and Premiums Surge

U.S. enrollment in Affordable Care Act (ACA) health plans fell by roughly three million in February compared to the prior year, new federal data show.

The Department of Health and Human Services (HHS) released a report on Friday attributing the 13% decline—from 22.1 million to 19.2 million enrollees—to a federal crackdown on fraudulent or “phantom” enrollment. However, health policy analysts contend the primary driver was the January 1 expiration of federal subsidies, which sparked sharp premium increases that many consumers could not afford.

“We know that real people lost their health insurance coverage,” said Cynthia Cox, vice president and director of the ACA program at the research nonprofit KFF, referencing survey data of those who exited their plans. “This coverage loss occurred amid double‑ or even triple‑digit premium increases for millions of enrollees.”

Compiled in April and reflecting February coverage, the data provide the administration’s first comprehensive view of how residents’ inability to pay initial premiums this year impacted overall enrollment, as the figures are captured after the nonpayment grace period expired.

A January federal projection indicated roughly 800,000 fewer individuals had enrolled in ACA plans year‑over‑year, the first decline in four years at that stage of the enrollment period.

KFF’s Cox anticipates the enrollment decline to continue through the year, possibly dipping to around 17.5 million—a notable reduction for the federal program that serves working‑age adults ineligible for Medicaid. In recent years, ACA plans have become a staple for gig workers, farmers, ranchers, hairstylists, and other self‑employed individuals lacking employer coverage.

The expiration of ACA subsidies this year sparked a contentious debate in Congress last fall, with Democrats and a handful of Republicans urging renewal. Amid steep premium increases across ACA and other insurance markets, voters increasingly cite affordability as a top issue heading into the November elections.

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