Overview
- Effectuated enrollment fell to about 19.2 million in February 2026 after roughly 23.1 million people signed up in January, a decline that reflects several million people leaving marketplace coverage.
- The main driver was the expiration of enhanced premium tax credits at the end of 2025, which KFF says caused average consumer costs to surge about 114 percent for many enrollees in 2026.
- HHS and CMS also report an administrative cleanup that blocked or ended about 2.9 million subsidized enrollments labeled by the agencies as improper, phantom, or unauthorized and logged roughly 342,000 complaints about unauthorized enrollments in 2025.
- Insurers are responding with large rate‑increase requests for 2027 and some announced selective market exits, with filings in sample states showing requested hikes from roughly 6.5 percent to more than 22 percent, which could further shrink plan choice and raise premiums.
- Rising uninsurance and shifts to less comprehensive coverage may reduce preventive care and raise uncompensated hospital costs, and many of the newly uninsured are eligible for Medicaid or subsidies, so state rules and local insurer participation will shape who loses coverage and how severely.