Overview
- Late June federal CMS data show effectuated marketplace enrollment fell by about 2.6–3.0 million people year‑over‑year, comparing February 2026 with February 2025.
- Health analysts say the main cause was the Jan. 1, 2026 end of pandemic-era enhanced premium tax credits, which sharply raised monthly costs and prompted many people not to pay initial premiums.
- The administration has pointed to a cleanup of improper or “phantom” enrollments as a contributor, but multiple researchers and watchdogs dispute that claim and link losses to subsidy cuts and nonpayment.
- Declines were uneven by state: Ohio and Oklahoma each lost roughly one‑third of enrollees while New Mexico posted about a 14% gain after it used state funds to replace the expired federal subsidies.
- Insurers are seeking sizeable 2027 rate increases (KFF finds a roughly 14% median request) and some carriers plan to leave exchanges, raising the risk that higher sticker prices and a sicker risk pool will widen coverage losses and heat up the 2026 political debate.