ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments
New federal data released Friday, June 26 shows ACA Marketplace Enrollment dropped 13% following the expiration of enhanced premium tax credits at the beginning of this year. Enrollment fell from a high of 22.1 million people in 2025 to 19.2 million people in February 2026. While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments – often in the double or even triple digits – with the expiration of enhanced tax credits.
While we do not yet know how many people have become uninsured, the ACA Marketplaces are often an option of last resort for people who do not have an affordable offer of coverage through their work and are ineligible for Medicare or Medicaid.
The report from Health and Human Services (HHS) contains the first look at 2026 ACA Marketplace effectuated enrollment, which takes into account whether enrollees have made their premium payments. Earlier reports had focused on signups, which were down by about 1 million or 5% from last year, but these data understated the degree of coverage loss. Unlike the signups numbers, effectuated enrollment totals do not include people who initially selected a plan or were automatically reenrolled by the Marketplace but later canceled their coverage or did not make their premium payments and had their coverage retroactively terminated.
Cynthia Cox
Senior Vice President
Director, Program on the ACA
Thanks for getting this important info out for people.
(I actually learned about the report and the coverage drops from Charles Gaba's Substack Friday. https://charlesgaba.substack.com/p/breaking-hhs-report-admits-trumpgop . You can't feel bad about Charles beating you to it. He is very fast, and beats every news source to getting info out, virtually all of the time!)
So, I have a comment on a prior KFF post which may be of interest to some:
https://kfforg.substack.com/p/trump-officials-still-delaying-funds/comment/282733840 from before this CMS data release
(The part of that post on the effect of the lapsed expanded subsidies, not the coming OBBB cuts.)
where we learn from a leak at CMS that apparently CMS delayed release of some of this data, that CMS saw that the coverage drops were large, and was planning to falsely claim the coverage drops were due to fraud reduction.
As you indicate, the attribution to fraud reduction is what they did:
"While the Trump administration attributes this drop in enrollment to their attempts to address fraud,"
And, that's the big question. Can we figure out how much truth there is to that?
So, I've been going through the CMS report from Friday myself, as well as this Paragon Health Institute report on fraud from a little earlier https://paragoninstitute.org/wp-content/uploads/securepdfs/2026/06/The_Persistent_Obamacare_Enrollment_Fraud_RELEASE_V1.pdf , to try to determine, as well as possible, exactly what caused the drop.
Thus, as you report, CMS is making the claim that the drops in ACA on exchange enrollment, which are 2.8 million (of about 22 million in 2025) so far, and expected to rise as the year goes on, are almost entirely due to fraud reduction.
So, I haven't completed a careful read of the document, nor an associated report from the Paragon Health Institute, and have so far found the CMS claim suspect.
In reading yesterday, I noted that there may be some reduction in cheating by the Trump administration's actions that is responsible for a part (only) of the coverage drop.
But, I think it will work out that the cheating reduction is likely largely to be people in the 9 or 10 Republican states that did not expand Medicaid (https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ ) , which cheating reduction was done by removing from coverage of people with incomes of below 100% of the Federal Poverty Level (FPL) who mis-stated or mis-guessed their income as between 100% and 150% of the FPL, thereby getting themselves health insurance when they otherwise would not have any health coverage at all. (FPL: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/ .)
Now, what everyone has to know, is that in a state that did not expand Medicaid, if your income is below 100% of the Federal Poverty Level (FPL) and you don't have employer-based insurance, then you don't have access to any affordable health insurance at all, unless you drop down to dirt-poor in BOTH income and assets to qualify for old-fashioned pre-ACA standard Medicaid.
And, what having no health insurance means is that you can go, in a medical emergency, to an emergency room, and they have to treat you under the Reagan-era EMTALA law--only to the point that your are medially stable. (You may still be quite sick. You will then have to try and find charity care of some sort somewhere for that sickness.)
And, with no insurance, you are still legally responsible for the cost of that EMTALA care!
Now, in such situation, would you perhaps try to cheat?
The president, vice president, and Mike Johnson
( https://normspier828307.substack.com/p/exploring-the-mass-deception-and ),
John Thune (https://normspier828307.substack.com/p/senate-republican-leader-john-thune ),
and Dr. Oz (https://normspier828307.substack.com/p/cost-sharing-reductions-silver-loading )
are men of extraordinary personal integrity, and in such a dire situation, they would, of course, never cheat, even one little bit.
But, I mean, ordinary people. in the working-poor zone. Perhaps they might cheat?
So, I have to read further the CMS report, and the earlier Paragon report on fraud. But that looks like how its going to turn out.
(People fond of the Paragon term "Phantoms", used in a few different ways, but generally for people who have health insurance but don't get sick enough to ever file a claim, will be excited to know that the term appears in both the new CMS report, as well as the slightly earlier Paragon report.
Both reports avoid using the term "fat cat" for a person with an income of 150% of the Federal Poverty Level, or lower. But, it's looking like that is what they are trying to get everyone to think.)