Overview
- Federal data show about 19.2 million people were enrolled in ACA marketplace plans in early 2026, roughly 3 million fewer than at the same time last year.
- HHS’s Assistant Secretary for Planning and Evaluation says its 2025 marketplace rule and follow-up enforcement removed or blocked about 2.9 million improper enrollments through February 2026 and estimates 5.6 million improper or phantom enrollments in 2025 with 2.6 million remaining.
- CMS reported roughly 1 million highly suspicious agent- or broker-assisted enrollments that lacked Social Security numbers and were not paying premiums, which HHS cites as evidence of broker-driven improper sign-ups.
- Researchers and advocates counter that the expiration of enhanced premium tax credits at the end of 2025 led to steep premium hikes, widespread nonpayment, and voluntary dropouts that also explain much of the enrollment loss.
- Insurers are seeking higher rates and some have signaled marketplace exits, which could reduce plan choice and raise costs for people who keep coverage and increase the risk of unpaid medical bills for those who go uninsured.