Overview
- Federal HHS/ASPE data show about 19.2 million people were enrolled in ACA marketplaces in February 2026, roughly 3 million fewer than last February and several million below the 2025 peak.
- HHS said part of the decline reflects a cleanup of improper or “phantom” enrollments that it estimated peaked at 5.6 million in 2025 while independent analysts attribute most of the drop to the Jan. 1, 2026 end of enhanced premium tax credits that sharply raised monthly costs.
- The February totals reflect the market after a nonpayment grace period expired, and ASPE estimated about four million people left coverage in their first month this year largely for failing to pay higher first premiums.
- Insurers have filed widespread double-digit rate increases for 2026 and some carriers have announced plans to exit marketplaces for 2027, moves analysts say could shrink competition and drive prices still higher.
- Public-health experts warn that losing coverage can reduce preventive care, worsen chronic disease outcomes, increase infectious disease spread, and raise uncompensated care at hospitals while KFF projects enrollment could fall toward about 17.5 million later this year.