ACA enrollment declines sharply as coverage costs skyrocket in 2026

Far fewer Americans have enrolled in a health care plan under the Affordable Care Act, new federal data shows, and millions face higher premiums after the insurance program’s tax subsidies 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 began on November 1. That’s a drop of 1.4 million from the number of Americans enrolled in Obamacare, as the health plans are called, a year ago.

Nationally, about 800,000 fewer people chose plans compared to the same time last year, representing a 3.5% drop in total enrollment so far. This includes a decrease in both the number of new consumers signing up for ACA plans and the number of existing subscribers renewing them.

ACA open enrollment in most states for February coverage ends January 15.

The decline in enrollment comes as many ACA participants face significantly higher monthly premiums due to a Dec. 31 expiration of tax credits that have reduced monthly household health plan costs. After months of debate and Government shutdown for 6 weeksCongress has yet to extend the appropriations or find another remedy.

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

More than 20 million Americans received ACA subsidies last year. Health policy group KFF estimates it could see its premiums rise an average of 114 percent, from about $888 in 2025 to $1,904 this year, unless the tax credits are extended.

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

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

“I predict that 2 million more people will be without health insurance for a period of time,” Kaestner told the Associated Press. “It’s a serious problem, but Republicans would say we’re using government money more efficiently, targeting people who really need it, and saving $35 billion a year.”

Edited by Alain Sherter

The Associated Press

contributed to this report.