With the elimination of enhanced premium tax credits, enrollment in Affordable Care Act health insurance exchange plans is falling.
Last year saw 24 million people enroll in ACA marketplace plans – an all-time high. 2026 enrollment, though, is down 1.2 million, or five percent – the largest year-to-year decline since the exchanges started offering health insurance in 2014. Overall, enrollment has fallen in 41 states, with those declines ranging from one to 22 percent.
In addition, 14 percent of those who signed up for plans in 2026, or who were automatically reenrolled because of past enrollment, did not pay their January premiums. While it is not yet clear whether some of those people will eventually pay, some have already had their plans terminated while others are shopping down – looking for less-costly but less-generous health plans with larger deductibles and fewer benefits.
Learn more about the effect of the elimination of enhanced premium tax credits on ACA health insurance enrollment from the Commonwealth Fund report “Emerging State Data Paint a Bleak Picture of 2026 Marketplace Enrollment.”