Obamacare Enrollment Drops Sharply as Costs Rise – Image for illustrative purposes only (Image credits: Unsplash)
Enrollment in Affordable Care Act marketplaces declined in 2026 following the expiration of enhanced federal premium tax credits at the end of 2025. Congress declined to extend the subsidies, which had kept costs low for millions of Americans during the previous five years.[1][2] Final plan selections totaled 23.1 million, a drop of 1.2 million from the record 24.3 million reported for 2025.[3][4] Analysts expect actual coverage numbers to fall further as some enrollees fail to pay higher premiums.
Final Tally Reveals a Clear Downturn
The Centers for Medicare & Medicaid Services released data showing 23.1 million consumers selected or were automatically re-enrolled in marketplace plans for 2026 coverage.[3] This figure marked the first decline since 2020, reversing a streak of growth fueled by the temporary subsidies.[5]
New consumer sign-ups fell sharply, dropping 14 percent in federal marketplace states from the prior year.[2] Returning enrollees numbered just under 19.6 million, a three percent decrease. State variations emerged, with North Carolina posting a 22 percent plunge and Ohio a 20 percent drop, while New Mexico saw an 18 percent rise thanks to state-funded replacements for the lost federal aid.[4][2]
Plan choices shifted toward cheaper options. Bronze plans captured 40 percent of selections, up 10 percentage points from 2025, while silver plans slipped to 43 percent, down nearly 14 points.[3] Gold plans gained modestly.
Subsidy Expiration Drives Premium Spikes
Enhanced premium tax credits, first introduced in 2021 and extended through 2025, eliminated premiums for many low-income households and reduced costs for middle-income families.[5] Their lapse meant subsidized enrollees faced an average 114 percent increase in monthly payments for the same plans.[2][5]
Returning customers received a three-month grace period to pay, ending March 31 for many, but affordability issues led to widespread cancellations.[5] Cynthia Cox, director of the program on the ACA at KFF, noted that those retaining coverage likely confronted higher premiums or deductibles.[2]
| Year | Total Plan Selections | Change from Prior Year |
|---|---|---|
| 2025 | 24.3 million | + (record high) |
| 2026 | 23.1 million | -1.2 million (-4.9%) |
Stakeholders Feel the Strain
Low- and middle-income Americans bore the brunt, as the subsidies had expanded eligibility and capped contributions at affordable levels.[2] Kevin Patterson, CEO of Connect for Health Colorado, highlighted enrollees choosing between health care and essentials like housing.[2]
Insurers reported early trends of higher disenrollments, with estimates from Wakely Consulting suggesting marketplace coverage could shrink by up to 26 percent from 2025 averages.[1] States without backfill programs saw steeper losses, though a few like Texas bucked the trend through other policies.[4]
- Bronze plans: 40% (up 10 points)
- Silver plans: 43% (down 14 points)
- Gold plans: 17% (up 4 points)
- New Mexico: +18% enrollment
- North Carolina: -22% enrollment
Path Forward Remains Uncertain
Plan selection data overstates true coverage, as effectuated enrollment figures will emerge later in 2026 and beyond.[5] Leslie Dach of Protect Our Care predicted ongoing monthly declines as payments falter.[2]
The Congressional Budget Office had forecasted around two million fewer covered lives without extension.[2] With midterms approaching, the issue may regain traction, though health care priorities have waned.[1] For now, higher costs reshape access for millions reliant on the marketplaces.