The Affordable Care Act, commonly known as Obamacare, is the federal law that created the insurance marketplaces where roughly 22 million Americans bought their health coverage in 2025. Starting in January 2026, the subsidies that had been making those plans affordable for lower- and middle-income households expired. No replacement was enacted. The result: average monthly premiums on ACA marketplace plans jumped 114 percent, from $888 in 2025 to $1,904 in 2026. Between the end of 2025 and February 2026, roughly three million people, about 13 percent of all ACA enrollees, dropped their coverage. It was the largest enrollment decline since the ACA marketplaces opened in 2014, and the first drop in ACA enrollment since the first Trump administration.
What the Subsidies Were
The subsidies that expired are called enhanced premium tax credits. Congress first created them in 2021 as part of the American Rescue Plan, the pandemic-era relief legislation. They were then extended through the end of 2025 by the Inflation Reduction Act in 2022. Together, those credits significantly reduced what households earning up to four times the federal poverty level paid each month for marketplace coverage. In 2025, the average subsidized enrollee paid $888 per month for their plan. For 2026, without renewal, that same enrollee faced an average bill of $1,904, an increase of just over $1,000 per month, or more than $12,000 per year. Some households, particularly older enrollees facing higher age-based premiums in states with less generous markets, saw their annual costs jump by $20,000 or more.
Who Was Hit Hardest
The enrollment drop was not evenly distributed. Young adults between roughly 26 and 34 saw a decline of 542,000 sign-ups, about 8 percent of that age group’s prior enrollment, and accounted for 46 percent of the total national decline. People ages 55 to 64, who already face the highest ACA premiums because marketplace plans can charge older enrollees up to three times the rate of younger ones, also dropped coverage at elevated rates. By state, enrollment fell most sharply in North Carolina, where sign-ups declined 22 percent; Ohio at 20 percent; West Virginia at 17 percent; and Indiana, Delaware, and Arizona each at 16 percent. States that stepped in with their own subsidy programs, including Connecticut, Maryland, Massachusetts, New Jersey, and New Mexico, saw enrollment hold steady or continue to grow.
What the Administration Says
The Trump administration and independent health policy researchers disagree on what is driving the decline. The administration has attributed a portion of the drop to fraud crackdowns, arguing that changes in eligibility verification are removing people who were improperly enrolled rather than people who genuinely lost access to affordable coverage. Independent researchers at the Kaiser Family Foundation, an independent health policy research organization, and the Center on Budget and Policy Priorities, a nonpartisan research institute, say the sharp rise in out-of-pocket costs is the primary driver. When premiums increase by 114 percent, those researchers note, the enrollment decline is the expected and predictable result.
What the Numbers Project Going Forward
The Congressional Budget Office, the official nonpartisan scorekeeper for federal legislation, estimates that the number of uninsured Americans will rise by 2.2 million in 2026, 3.7 million in 2027, and approximately 3.8 million per year in each of the following years of the decade, as a direct result of the subsidy lapse. The figures from early 2026 reflect open enrollment sign-ups made late last year; researchers project additional mid-year coverage terminations as people who tried to keep their plans find the new monthly bills unworkable. Deductibles have also surged, with some analyses finding the average ACA marketplace deductible jumped by roughly $1,000 in 2026 compared to the prior year. No legislation to renew the enhanced premium tax credits has advanced in Congress.
Where It Stands
The enhanced premium tax credits that made ACA coverage affordable for millions of Americans expired on December 31, 2025. Congress has not acted to restore them. Three million people have dropped their coverage since, with researchers projecting the losses will deepen through 2026 and beyond. The states that kept enrollment stable did so by funding their own replacement subsidies, a patchwork approach that leaves the largest declines concentrated in states that did not or could not fill the gap. For the households that have dropped coverage since January, the question is not one of policy abstraction. It is whether they can afford to see a doctor.