ACA enrollment sinks sharply as coverage costs soar in 2026
The latest data from the Centers for Medicare and Medicaid Services (CMS) reveals a significant decrease in the number of Americans enrolling in Affordable Care Act (ACA) health care plans for 2026. Since open enrollment began on November 1, only 22.8 million people have signed up for ACA coverage, representing a drop of 1.4 million compared to the previous year.
This decline in enrollment can be attributed to the expiration of tax subsidies under the ACA program in December. As a result, many participants are facing higher monthly premiums, prompting them to reconsider their insurance coverage. Nationally, there has been a 3.5% decrease in total enrollment, with both new consumers and existing enrollees opting out of ACA plans.
The current open enrollment period for February coverage in most states ends on January 15. Despite ongoing debates and a government shutdown, Congress has yet to extend the tax credits that previously lowered households’ monthly health plan costs. The House recently passed a bill that could preserve the enhanced subsidies for another three years, but its fate now rests with the Republican-controlled Senate.
It is estimated that over 20 million Americans received ACA subsidies last year, and without an extension of the tax credits, their premiums could increase by an average of 114%. This significant rise in costs may lead more individuals to forgo their coverage due to financial constraints. The Congressional Budget Office predicts that 4 million people could lose their insurance if the credits are not extended.
Health economist Robert Kaestner from the University of Chicago warns that the end of subsidies could result in 2 million more people lacking health insurance for a period of time. While some may have alternative options like joining a partner’s employer health plan or qualifying for Medicaid, others may risk going without insurance while seeking alternatives.
The potential impact of higher premiums and out-of-pocket expenses on ACA enrollees underscores the importance of extending the tax credits to ensure affordable health care coverage for millions of Americans. As the debate continues in Congress, the future of ACA subsidies remains uncertain, leaving many individuals and families facing uncertainty about their health insurance options.
