Health Insurance Enrollment Drops Amid Subsidy Disappearance

With the end of Affordable Care Act (ACA) subsidies, many households are facing significant increases in health insurance costs.

A recent report from the Centers for Medicare and Medicaid indicates that there are 1.4 million fewer individuals enrolled through ACA Marketplaces this month compared to January 2025. States like Florida, Ohio, North Carolina, and Georgia have recorded the steepest declines.

“Access to care has diminished, often leading to worse health outcomes,” mentioned Matthew Fiedler, a senior fellow at the Brookings Institution. He noted that the financial stability of numerous families is in jeopardy: “They’ll face higher bills, which may hurt their credit, or they might pay up but cut back in other areas.”

Business Insider has analyzed these enrollment trends by state and consulted experts about the nuances of this CMS data, suggesting it doesn’t fully reflect the current state of marketplace enrollment for 2026.

Low- and Moderate-Income Americans Facing Increased Health Care Costs

The decline in marketplace enrollments was particularly pronounced in the South and Southeast, though most states observed drops. However, over 260,000 people registered in Florida, and there were increases in states like Texas and California.

People often opt for marketplace plans when their employer doesn’t provide insurance, they are self-employed, have lost their jobs, or earn too much to qualify for Medicaid. So, the current drop of 1.4 million is quite concerning. Between 2015 and 2025, marketplace registrations surged from 11 million to over 24 million.

Enhancements to ACA subsidies, which were enacted in 2021 and set to expire on December 31, made health insurance more accessible for many low- and middle-income Americans. This allowed individuals with incomes up to 400% of the poverty line—about $128,600 annually for a family of four—to access financial relief for medical costs.

KFF estimates that without these credits, people could see their insurance premiums more than double compared to last year.

The White House Press Secretary, Khush Desai, told Business Insider, “ACA enrollment has decreased by 3.5% from 2025 to 2026.” He attributed this entirely to actions taken by the Trump Administration aimed at reducing waste and ensuring that those who were improperly enrolled in subsidized plans were eliminated.

The debate over renewing these credits has caused tension between Democrats and Republicans in Congress, which has contributed to the recent government shutdown. Lawmakers decided against renewing the subsidies last December, and the latest discussions about the ACA in the Senate have been postponed until the end of January.

While Republicans claim they are working towards a compromise healthcare strategy, the plan detailed in a report from President Donald Trump, released on January 15, does not address subsidies. The report instead focuses on lowering drug prices and premiums, enhancing cost-sharing initiatives, and improving cost transparency.

“The main structure of the plan seems contradictory,” remarked Gideon Lukens, a senior fellow at the Center on Budget Policy and Priorities. “There are many unanswered questions about its functioning, who will benefit, and why it would be preferable to directly covering national insurance premiums to mitigate the skyrocketing costs many face.”

Further Declines in ACA Insurance Expected

Policy analysts have informed Business Insider that they anticipate a further drop in ACA enrollment in the upcoming months. The January report captures market conditions but comes with some important notes.

The latest statistics show how many Americans enrolled in Marketplace plans during the open enrollment period or had their existing ACA plans automatically renewed. However, this data does not clarify how many individuals have actually paid for their health insurance, and as bills start rolling in, more people may choose to cancel their coverage. A recent report from the Congressional Budget Office suggests that nearly 4 million Americans could lose or have their insurance terminated over the next decade.

“It’s likely that many signed up without knowing the actual premiums they would end up facing, and they’re just waiting to see what those will be,” indicated Matthew Buttgens, a senior research fellow at the Urban Institute.

Fiedler speculated that state-level healthcare policies might explain the enrollment increases in certain areas. For example, California has its own ACA subsidies, making residents less susceptible to changes at the federal level.

The expiration of ACA credits also has implications beyond individual patients; Fiedler noted that it could intensify pressures on hospitals. They may experience a surge of uninsured patients, which might deter people from seeking medical treatment altogether.

“This situation could be the tipping point for facilities that were already in precarious financial positions,” he added.