Obamacare just lost about 1.2 million enrollees in its sharpest drop ever
For years, the steady expansion of the Affordable Care Act marketplace was celebrated in Washington as proof that the program worked.
Enrollment more than doubled between 2020 and 2025, from roughly 11.4 million to a record 24.3 million, and early retirees were signing up for coverage they could finally afford.
That streak is now over, and the shift is dramatic enough to reshape discussions around health insurance affordability before the election. Millions of families are already rethinking how they manage healthcare costs.
If you buy your own health insurance through the ACA marketplace, or know someone who does, the latest federal data could directly affect what you pay and the coverage tradeoffs you face for the rest of 2026.
ACA marketplace enrollment posts its sharpest single-year decline on record
Roughly 23 million Americans selected ACA marketplace health plans during the 2026 open enrollment period, down from the 24.3 million who enrolled in 2025, CNBC reported.
That decline represents the largest raw enrollment decrease since the ACA marketplaces launched over a decade ago, according to KFF, a nonpartisan health policy research group.
The decline reverses four consecutive years of record growth that pushed ACA enrollment from roughly 11 million in 2020 to its all-time high. Health policy researchers attribute that expansion to the enhanced premium tax credits Congress enacted in 2021 under the American Rescue Plan, which the Inflation Reduction Act later extended through the end of 2025.
Those subsidies expired after Congress failed to reach a deal to extend them, triggering the enrollment drop federal data now confirms.
KFF's analysis projects that average effectuated enrollment across 2026 could fall to around 17.5 million from 22.3 million in 2025, a 21.5% decline at the midpoint of Wakely Consulting Group's projected 17%-26% range.
Premium payments jumped 58% as the ACA subsidy cliff returned
Average monthly premium payments for ACA enrollees climbed 58%, rising from $113 in 2025 to $178 in 2026, KFF found. That increase landed well below the 114% spike the organization had originally projected if all enrollees stayed in the same health plan they held the year before.
People are trying to hang on to their health insurance coverage any way they can, even if that means they have a deductible of $7,000
The gap between forecast and reality exists because millions of enrollees downgraded their health plans to keep monthly costs manageable, the KFF report found.
About 9.2 million people signed up for bronze-tier plans in 2026, a sharp jump from 7.3 million in 2025, and those plans carry lower monthly premiums but expose enrollees to substantially higher out-of-pocket costs.
That mass migration to cheaper plans drove the average deductible across all ACA marketplace plans up by 37%, from $2,759 to a record $3,786, which KFF described as the steepest deductible jump in marketplace history.
For enrollees who need hospitalizations or prescriptions, that higher deductible means thousands more in expenses before insurance begins covering costs.
Middle-income households near the subsidy cliff bore the heaviest losses
The expiration of enhanced subsidies brought back the so-called "subsidy cliff," a threshold that eliminates all premium tax credit eligibility for households earning more than 400% of the federal poverty level. That cutoff, based on the 2025 federal poverty guidelines used for 2026 ACA eligibility, is roughly $62,600 for a single person and $128,600 for a family of four.
Enrollees with incomes above that cliff made up just 7% of 2025 marketplace sign-ups but accounted for nearly half (about 48%) of the total decline in plan selections from 2025 to 2026, the KFF analysis found. Those earning between 400% and 500% of the poverty level accounted for 27% of the decline in enrollment.
More Health Care:
- If your Medicare plan was canceled, do this now
- Health care costs are the wild card in year-end tax planning
- 22 million Americans hit by ACA health insurance cliff after vote fails
"No matter how you slice it, people are paying more," Cox noted. The projected drop-off turned out far steeper than initial federal data suggested, revealing how sharply rising costs are pushing working families out of the insurance market.
This subsidy cliff creates a particularly painful bind for households that sit just above the income threshold, where a modest raise or a spouse's part-time earnings can eliminate thousands of dollars in annual premium support overnight.
The political and financial fallout could extend through the 2026 midterms
The enrollment decline carries significant political weight because most of the ACA marketplace growth since 2020 has occurred in states that voted for Trump in the 2024 election. About 88% of the 12.9 million new enrollees added between 2020 and 2025 were in states Trump won in the 2024 election, a KFF analysis of federal data showed.
"The health policy debate in recent years really has been predominantly about costs, as the coverage challenge had largely been resolved," Jonathan Burks, executive vice president for economic and health policy at the Bipartisan Policy Center, told CNBC in January. "Expiration of the enhanced subsidies has reopened that coverage debate."
The Trump administration has attributed most of the enrollment decline to federal anti-fraud efforts in the ACA program, CNBC reported. The Centers for Medicare and Medicaid Services, which has not yet released final 2026 enrollment figures, did not respond to a request for comment on the KFF analysis.
A KFF survey published in March found that 55% of enrollees who re-enrolled for 2026 had cut or planned to cut spending on necessities like food and clothing to afford their healthcare costs. An additional 17% of returning ACA Marketplace enrollees said they were not confident they would be able to afford their premiums for the full year.
For millions of Americans who rely on the marketplace for coverage, the months ahead will test whether the remaining federal subsidies are enough to keep these households insured, and clarity will become clearer as 2026 unfolds.
Related: White House's 'Great Healthcare Plan' sounds big - what's the catch?
The Arena Media Brands, LLC THESTREET is a registered trademark of TheStreet, Inc.
This story was originally published May 21, 2026 at 6:37 PM.