New federal data show roughly 5 million people dropped Affordable Care Act marketplace plans for 2026 as premiums spiked after Congress allowed enhanced premium tax credits to expire. HHS reported 19.2 million people signed up for ACA plans as of February, down from about 23.1 million in January, a decline experts tie to sharply higher net premiums and out-of-pocket costs. Trump administration officials attribute part of the drop to fraud and unpaid enrollments, while health policy researchers point to the expiration of enhanced subsidies that doubled premiums for many enrollees. Early-month data suggest several million who selected plans then failed to pay first-month premiums, driving a steeper-than-usual falloff. State-level variation appeared: Pennsylvania saw a slight enrollment increase early in the year even as its net premiums rose less than in most states, while overall enrollment fell in other states. Analysts warn the February snapshot will likely understate total 2026 coverage losses as more people face higher monthly bills through the year.
