Medical costs could skyrocket as ACA subsidies expire
Millions are at risk of skyrocketing health costs in 2026 if Congress fails to extend health care subsidies.
More than 3 million people enrolled in Affordable Care Act plans lost coverage this year as monthly premiums increased and enhanced subsidies meant to make health insurance plans more affordable expired.
About 19.2 million people were enrolled in ACA plans as of February, down from the 23.1 million people who had coverage by January 2026, the U.S. Department of Health and Human Services reports. As of January 2025, approximately 24.2 million people have subscribed.
While the expiration of enhanced ACA subsidies at the end of 2025 will result in higher premiums for millions of consumers, a report from HHS’s Assistant Secretary for Planning and Evaluation cited efforts to crack down on inappropriate contracts.
The report said nearly half of the ACA enrollment growth from 2021 to 2024 is “suspected to be inappropriate, fictitious, or fraudulent.”
The HHS report said the Trump administration’s efforts prevented the enrollment of 2.9 million people who were “fraudulently receiving subsidies for which they were not eligible.”
But experts who track ACA enrollment said affordability is likely the driving force behind enrollment declines. The average cost for ACA members who want to keep their insurance plans rose 114% in 2026 after Congress failed to extend enhanced subsidies that expired at the end of 2025, according to KFF, a health policy nonprofit.
“The simple fact is that when you raise the price of a good or service, fewer people buy it,” said Sabrina Corlett, co-director of Georgetown University’s Center on Health Care Reform. “That’s what we’re seeing in medical practice.”
Private health insurance companies that sell ACA plans and the nonpartisan Congressional Budget Office also predict a significant drop in enrollment as consumers have to pay more to maintain their plans, said Cynthia Cox, vice president and ACA program director at KFF.
The drop in enrollment is “really not surprising,” Cox said. “These numbers are in line with what everyone expected going into this year.”
How much has the number of registrants decreased?
Cox said there is a difference between the number of consumers signing up for a plan and the number of consumers making the monthly payments required to maintain coverage. Coverage for individuals who sign up for an ACA plan will be terminated if they miss a monthly payment.
Comparing the number of people whose registrations were “activated” by making monthly payments, the number of registrants decreased from 22.1 million in 2025 to 19.2 million in February 2026.
KFF predicts that enrollment will likely decline further as some people struggle to make monthly payments while facing other expenses such as housing and groceries. According to a KFF survey, 17% of enrollees said they were not confident that they would be able to pay the health insurance premiums for the entire year 2026.
A report from the Georgetown Center for Health Care Reform released on June 18 suggests that health insurance companies will likely raise rates again next year. Georgetown researchers analyzed filings from health insurance companies in nine states and Washington, DC. Insurers in those states are seeking premium rate increases in 2027, ranging from 6.5% in Vermont to 22.4% in Washington. The deadline for insurers to submit to the federal marketplace to cover Americans is not scheduled until mid-July.
Why does HHS cite fraud?
HHS cited the Trump administration’s efforts to ensure federal aid is available to eligible enrollees. These efforts prevented 1.5 million enrollees from receiving subsidies for which they were not eligible and suspended or blocked an additional 1.4 million enrollees, HHS said.
HHS estimated that 2.6 million “inappropriate fictitious registrations” may still be in progress, including registrations without Social Security numbers. The HHS report provides no further details or evidence regarding these numbers.
The Centers for Medicare and Medicaid Services said in a Federal Register filing that it processed about 342,000 “fraudulent enrollment” complaints in 2025. It describes a case in which a broker enrolled a consumer in an ACA plan without the consumer’s consent.
Although fraud remains an issue, most consumers are opting out of insurance due to affordability concerns, Corlett said.
“The numbers are bad,” Corlett said. “It’s not a good thing that millions of people can’t afford health insurance.”
