ACA enrollment drops by 1M-plus after subsidies expire

Affordable Care Act (ACA) enrollment dropped by more than a million after enhanced subsidies expired last year, causing monthly insurance premiums to skyrocket. 

The Centers for Medicare and Medicaid Services (CMS) reported Wednesday that 23 million people signed up for open enrollment, which concluded on Jan. 15. It marks a drop-off from the 24.2 million people who enrolled for insurance during the same period in 2025.

Last year marked four consecutive years of record enrollment for ACA Marketplace plans. Gains were credited to enhanced premiums tax credits signed into law under former President Biden through the American Rescue Plan and extended by the Inflation Reduction Act.

Heightened prices reflect the expiration of the COVID-19 pandemic-era tax credits, which kept health insurance costs lower for struggling Americans. The issue was a major flashpoint in spending talks last year, and the turmoil resulted in a 43-day record-long government shutdown.

Democratic lawmakers have pushed for a three-year extension of the subsidies, but the House-passed bill has stalled in the Senate.

Health care advocates have decried the decision to allow premiums to skyrocket, citing harsh conditions that may require citizens to choose between food and medical care.

“Having folks get off the system will derail the entire health care marketplace, especially as more people will unenroll after they receive their first bill,” Rep. Adam Smith (D-Wash.) said in a statement this week, noting thousands in his home state are now uninsured because they “cannot make ends meet.”

His concerns were echoed by Kevin Patterson, CEO of Connect for Health Colorado, who said he’s seeing similar drop-offs.

“On one hand, it’s encouraging to see enrollment remain relatively steady, with only a slight dip, and to see so many people receive meaningful financial assistance,” Patterson said in a statement. “On the other hand, it’s deeply troubling that a record number of people are canceling their plans because they simply can’t afford their monthly payments, or are being forced to choose between health care and basic necessities like housing and food.”

He added, “Without federal enhanced Premium Tax Credits, this alarming trend is, sadly, emerging across the country.”

The latest numbers reflect the data from the 30 states that use the federal ACA Marketplace. Some states that rely on their own independent exchanges have open enrollment until later this week, which could affect the enrollment numbers.

“These numbers are going to go dramatically down month after month as people decide that they can’t afford health care and stop paying their premiums,” Leslie Dach, chair of Protect Our Care, an advocacy group, said in a statement, according to CNN.