Enrollment in Affordable Care Act (ACA) marketplace plans dropped by more than 1 million for the 2026 coverage year following the expiration of enhanced premium subsidies, according to federal data released this week.
The Centers for Medicare and Medicaid Services (CMS) reported that 23 million people signed up during the open enrollment period that concluded on Jan. 15, a decrease from the 24.2 million who enrolled during the same period in 2025.
This downturn officially ends a four-year streak of record-high enrollments seen under the Biden administration, which was largely attributed to the availability of enhanced premium tax credits.
According to the CMS, the number of returning customers fell to 19.6 million this year, compared to 20.2 million in 2025. Healthcare advocates have warned that enrollment may continue to decline as consumers face higher premiums that they find increasingly difficult to afford.
Representative Adam Smith (D-Wash.) cautioned in a statement that the loss of enrollees could “derail the entire health care marketplace,” noting that many individuals are already becoming uninsured because they “cannot make ends meet.” Smith predicted further drops in enrollment as more participants receive their first bills of the year.
While the federal sign-up deadline has passed, final figures remain subject to change because several states and territories, including California, New York, and Illinois, have extended their open enrollment windows until Jan. 31.
In Washington, legislative efforts to revive the subsidies remain in flux. Senator Bernie Moreno (R-Ohio) stated that Republicans would soon present their “best and final” offer to Democrats regarding the credits. Moreno told reporters the proposal would represent the maximum agreement he could reach within his conference.
A viable option for some of those leaving ACA and looking for alternatives can be found through healthcare sharing ministries. Unlike traditional insurance, healthshare programs are community-based arrangements where members contribute funds to help pay for each other’s medical expenses and often have lower monthly costs.