Health Policy · October 3, 2026, 11:29 AM CDT
Key Facts
- The Affordable Care Act’s enhanced premium tax credits expired at the end of 2025.
- Marketplace coverage that people were actually paying for fell to 19.2 million in February 2026, down 12% from 21.8 million a year earlier.[3]
- Average premium payments rose 58%, from $113 to $178 a month, and the average deductible rose 37%, to $3,786.[2]
- In a KFF survey, 9% of people who had Marketplace coverage in 2025 said they were now uninsured.[4]
The aftermath of the Affordable Care Act’s biggest subsidy lapse did not arrive as one headline number. It arrived as thousands of small decisions at kitchen tables, and the data now shows what those decisions added up to.
Most of the new numbers come from KFF, the health-policy research group. The federal government’s own estimates tell a partly different story, and we cover both. We read each source directly and list them all below.
What expired, and why it mattered
The ACA created the premium tax credit to lower what eligible households pay for marketplace plans.[5]
The American Rescue Plan Act of 2021 expanded eligibility for the credit and its size for tax years 2021 and 2022. The Inflation Reduction Act extended that boost through tax year 2025.[5]
The Congressional Research Service describes the effect this way: the enhanced credit “allowed more households to become eligible for the credit and provided larger subsidies to all eligible households.”[5]
Congress did not extend it past 2025.
1. The first count looked mild
In early February, KFF reported that plan selections for 2026 were “down by over 1 million people compared to the same time last year.” It was the first decline since 2020.[1]
That figure was misleading, and KFF said so. Plan selection counts people who signed up. It does not count people who then paid their first bill.[1]
KFF also warned that “it will be quite a while before we get a complete picture of how much enrollment has dropped.”[1]
2. The real drop showed up in who kept paying
The July data was the first national look at effectuated enrollment, which means people whose coverage is active because they paid. It stood at 19.2 million, down from 21.8 million a year earlier. That is a 12% fall, the first in seven years.[3]
The share of sign-ups that turned into paid coverage dropped from 90% to 83%.[3]
The federal government’s own figure for February 2026 matches: an estimated 19.2 million people enrolled in ACA exchange plans.[6]
Video: CBS News — “Affordable Care Act enrollment drops by nearly 3 million as costs rise after subsidies expire”.
3. People who stayed paid more and got less
KFF had projected that premium payments would rise 114% for subsidized enrollees who kept the same plan. The measured average increase was smaller: 58%, from $113 to $178 a month.[2]
The smaller number is partly a sign of what people gave up. Bronze plans went from 30% of selections to 40%, and silver plans fell from 57% to 43%.[2]
Bronze plans cost less each month but carry higher deductibles. The average deductible rose from $2,759 to $3,786. KFF called that “the steepest increase ever in the average Marketplace deductible since the markets launched in 2014.”[2]
The lowest-income shoppers pulled back too. In states that use the federal marketplace, the share of eligible consumers choosing a cost-sharing-reduction plan fell from 66% to 45%.[2]
4. Where you live decided how hard it hit
States that use the federal marketplace lost 15% of enrollment. States that run their own marketplaces lost 6%.[3]
Ohio and Oklahoma each fell by more than 32%, and Arizona by 30%. South Carolina, Indiana, Michigan, Minnesota, Mississippi and Louisiana fell 26% to 29%.[3]
New Mexico was the only state that grew, by 14%. It “fully replaced the expired federal enhanced premiums tax credits with state-funded subsidies.”[3]
The ten states with the lowest effectuation rates all use the [federal marketplace] platform, while the ten states with the highest effectuation rates are all state-based Marketplaces.[3]
Mississippi had the lowest effectuation rate, at 61%. New Mexico had the highest, at 96%.[3]
5. The administration says some of the drop is clean-up
The Department of Health and Human Services offers a different reading of part of the decline. In a June 26 issue brief, its policy office estimates that about 5.6 million people were improperly enrolled in 2025.[6]
HHS says the Trump administration removed about 1.5 million of them. It says another 1.4 million were removed or blocked from enrolling through additional program-integrity measures. It estimates that about 2.6 million improperly enrolled people remained in 2026.[6]
Those are the department’s estimates, and we have not found independent verification of them. They do not explain the premium and deductible increases above, which hit people who were properly enrolled.
6. What enrollees say happened to them
KFF surveyed 1,117 adults who had Marketplace coverage in 2025, from February 12 to March 2, 2026. The margin of error is plus or minus 4 percentage points.[4]
- 9% said they dropped coverage and were now uninsured.
- 28% switched to a different Marketplace plan.
- 51% said health care costs were “a lot higher” this year.
- 17% were not confident they could afford their premiums.
- Among those who re-enrolled, 55% had cut or planned to cut spending on food or other basics. For people with chronic conditions the figure was 62%.
One respondent put it plainly: “The end of ACA subsidies caused a huge increase in premiums, the cost of which I could not afford.”[4]
What is not yet known
These figures are not final. KFF says complete data that accounts for every grace period will not arrive until summer 2027.[1]
Its May analysis projected that average 2026 enrollment could land between 16.5 and 17.5 million, down from 22.3 million in 2025. That is a projection, not a count.[2]
The CBS video above carries a larger headline number, “nearly 3 million.” We have not verified where that figure comes from or what it measures, so this article relies on KFF’s counts.
The survey tells us what people said about their own situation. It does not show how many people are uninsured nationwide.
Every data set in one table
Each number used in the charts above, side by side, with its source.
| Measure | 2025 | 2026 | Source |
|---|---|---|---|
| Paid enrollment, Feb | 21.8M | 19.2M | KFF, Jul 28; HHS ASPE (2026) |
| Effectuation rate | 90% | 83% | KFF, Jul 28 |
| Avg monthly premium payment | $113 | $178 | KFF, May 19 |
| Avg deductible | $2,759 | $3,786 | KFF, May 19 |
| Bronze share of selections | 30% (7.3M) | 40% (9.2M) | KFF, May 19 |
| Silver share of selections | 57% | 43% | KFF, May 19 |
| CSR plan share, federal-marketplace states | 66% | 45% | KFF, May 19 |
| Enrollment change, federal-marketplace states | — | −15% | KFF, Jul 28 |
| Enrollment change, state-run marketplaces | — | −6% | KFF, Jul 28 |
| New Mexico enrollment change | — | +14% | KFF, Jul 28 |
| Avg enrollment (2026 projected) | 22.3M | 16.5M to 17.5M | KFF, May 19 |
| Enrollees now uninsured (survey) | — | 9% | KFF, Mar 19 |
| Improperly enrolled (HHS estimate) | 5.6M | 2.6M | HHS ASPE, Jun 26 |
How to Verify This Yourself
- Open the KFF pages and the HHS and CRS documents below and search each for the figure quoted here.
- Compare plan selections (sign-ups) with effectuated enrollment (paid coverage). They measure different things.
- Check your own state’s number in the July 28 state-by-state analysis.
What You Can Do Right Now
- If you buy through the Marketplace, check the federal marketplace site or your state exchange for 2027 enrollment dates and window-shop plans before you auto-renew.
- Compare total yearly cost, not just the monthly premium. A low-premium bronze plan can cost more if you need care.
- Ask whether your state offers its own subsidy on top of federal help.
References
- KFF, “ACA Marketplace Enrollment is Down in 2026—But All of the Data Isn’t in Yet,” February 5, 2026. Primary (research analysis). kff.org
- KFF, “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles,” May 19, 2026. Primary (research analysis). kff.org
- KFF, “How Has ACA Marketplace Enrollment Changed Across States in 2026?” July 28, 2026. Primary (research analysis). kff.org
- KFF, Follow-Up Survey of Marketplace Enrollees, fielded February 12–March 2, 2026, published March 19, 2026. Primary (survey). kff.org
- Congressional Research Service, “Enhanced Premium Tax Credit Expiration: Frequently Asked Questions” (R48290), December 4, 2024. Primary (nonpartisan congressional analysis). congress.gov
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “ACA Exchange Enrollment in 2026,” issue brief, June 26, 2026. Primary (government report; improper-enrollment figures are HHS estimates). aspe.hhs.gov
Investigative methodology: every figure above was read from the linked KFF, HHS and CRS documents. Quotation marks mark exact wording from those pages. No figure was estimated or filled in by us.
Kemetic Minds Editorial Desk
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