Obamacare enrollment drops after Trump administration ends enhanced benefits (representational image)
More than five million Americans dropped the Affordable Care Act (ACA), or Obamacare, and health insurance plans after enhanced federal support expired, leading to sharp increases in insurance premium costs and reigniting a political battle over former President Barack Obama’s health care law.New data released by the U.S. Department of Health and Human Services (HHS) on Friday showed that 19.2 million people were still enrolled in ACA marketplace plans in 2026. That’s down from the record 24.2 million enrolled in 2025, with the number of people choosing plans during open enrollment falling by more than 1 million, and another four million afterward dropping coverage or failing to pay premiums.The sharp decline comes after enhanced tax breaks expire after President Donald Trump and Republicans in Congress refused to extend relief provided during the Covid-19 pandemic under the Biden administration.
Democrats sought to preserve the financial aid until the federal government shutdown in October 2025 during negotiations over extending the program.The Affordable Care Act, widely known as Obamacare after former President Barack Obama, dramatically expanded health insurance coverage after its passage in 2010. Supporters say the temporary enhanced subsidies made coverage unaffordable for millions, while Republicans and the Trump administration have alleged the program has become vulnerable to fraud and improper enrollments.
According to the Department of Health and Human Services, current enrollment is 19.2 million. The department’s report also highlighted concerns about fraudulent and incorrect registrations, saying the Trump administration’s efforts are reducing such cases.However, many health policy experts attributed this decline primarily to rising insurance costs rather than fraud.“The main takeaway is that enrollment is down 13% from last year,” explained Cynthia Cox, director of KFF’s program on the ACA.
“While the Trump administration attributes this decline in enrollment to its attempts to address fraud, this loss of coverage occurred at the same time that millions of people faced double or even triple-digit increases in their premium payments as enhanced tax credits expired.”Health policy experts said enrollment rates rose between 2021 and 2025 because enhanced support significantly reduced tuition costs.“The market doubled in size during the period when subsidies were enhanced because coverage was more affordable and more attractive to people,” Cox said.Average premium costs nearly doubled between 2025 and 2026 after enhanced tax credits expired, prompting many consumers to leave the market.“When their costs went up, a lot of them dropped their coverage,” Cox said.The Trump administration has cited fraud as a major reason behind the previous surge in Obamacare enrollment, citing arguments made by the conservative Paragon Health Institute.
But many independent health care experts dispute this interpretation.“I don’t see data that points to that conclusion that a 5 million drop in population can be explained by fraud allegations,” said Stacy Pugh, a senior research fellow at the Georgetown Center for Health Insurance Reform. “There’s a lot of evidence to suggest that people make decisions based on what they can afford to pay each month.”Experts said that the rise in insurance premiums also created challenges for insurance companies.
Several companies, including Cigna, have announced plans to withdraw from ACA markets in some regions, raising concerns about reduced competition and higher prices.“If there are fewer customers, it makes the market less attractive to insurers,” Cox said.Healthier individuals are more likely to drop coverage, which could weaken insurance markets over time, she said. However, she does not believe that markets are currently at risk of entering a so-called “death spiral.”“I think there are still enough people buying ACA market coverage that this will keep these markets running,” she said. “At this point, we don’t see any parts of the country at risk of not having an insurance company. If that happens, this is what a death spiral might look like.”Early 2027 insurance filings indicate that premiums are likely to rise again next year, suggesting that enrollment may continue to decline unless Congress reconsiders financial assistance for ACA policyholders.The issue is expected to become a major debate in health care ahead of the midterm elections in November, as Democrats blame Republicans and the Trump administration for allowing subsidies to lapse, while the administration continues its anti-fraud campaign to improve the health of the Obamacare market.