Decline in Affordable Care Act Enrollment for 2026

Federal data released on Wednesday shows that enrollment in the Affordable Care Act for 2026 has dropped by over 1 million. This decline follows the end of enhanced federal subsidies, which previously helped keep monthly premiums lower for many enrollees.

Currently, nearly 23 million individuals have selected plans for 2026, down from approximately 24.2 million around the same time last year, according to the Centers for Medicare and Medicaid Services. This figure accounts for all enrollments in the 30 states using the federal exchange, with open registration concluding on January 15th. It’s worth noting that some states operating their own exchanges may still allow registration until the end of this month.

Experts are predicting further reductions in enrollment as the month progresses. Many people typically auto-enroll, and they might be taken aback by the higher premiums once they receive their first bills. This scenario might lead to some opting out of insurance entirely or failing to pay, resulting in disenrollment by April.

Leslie Duck, president of the advocacy group Protect Our Care, emphasized that the current statistics don’t fully capture the situation. “These numbers will likely drop significantly as individuals realize they cannot afford their healthcare and cease premium payments,” she stated.

Cynthia Cox, the ACA program director at KFF, mentioned that those who remain insured are likely to face steeper premiums or higher deductibles, especially as enhanced subsidies fade. KFF estimates that premium rates could see an average increase of about 114% this year.

The Congressional Budget Office has forecasted a potential drop of 2 million in Obamacare enrollment this year due to the end of those generous federal supports.

This aid was made available through the Biden administration’s 2021 COVID-19 relief package, but it is set to expire at the end of 2025. Those enhanced subsidies caused a notable increase in enrollment, particularly among low-income Americans who could gain coverage at minimal or no cost, and even helped some middle-class applicants who previously didn’t qualify for assistance.

The attempt to renew these subsidies led to significant political turmoil in Congress, resulting in a record-long government shutdown last fall. Although there were efforts to link federal funding to the extension of these subsidies, compromises were made. Recently, the House voted to extend the subsidy for three years—with some bipartisan support—but the bill has faced strong opposition in the Senate.

This drop in enrollment for 2026 marks the first decrease since 2020 when 11.4 million individuals selected plans. Enrollment had been steadily declining throughout Donald Trump’s presidency.

Interest in the 2026 Obamacare plan appears to have diminished, particularly among newcomers. Approximately 3.4 million consumers signed up for new insurance policies, which is a 14% drop from the prior year. Returning customers also decreased slightly, to just under 19.6 million.

North Carolina and Ohio saw the largest declines in enrollment, with drops of 22% and 20%, respectively. Conversely, New Mexico experienced a 14% increase in plan options, while the District of Columbia saw a 9% rise.

States running their own exchanges are also witnessing reductions as more individuals opt to cancel their plans this year.

In Colorado, enrollment reached just over 277,000 by the close of the state’s enrollment period, reflecting a 2% decrease from last year. Notably, new sign-ups plummeted by nearly 25%, despite Colorado implementing its own premium subsidy programs to fill the gap left by the federal enhancements.

Kevin Patterson, CEO of Connect for Health Colorado, expressed a mixed outlook: “We’re pleased that enrollment has remained relatively stable with only a slight decline, and that many people are receiving meaningful financial help. Yet, it’s disheartening that so many are canceling plans because of unaffordable monthly payments or having to choose between healthcare and basic living essentials like housing and food.”