Enrollment in individual health insurance plans, including those sold on the Affordable Care Act's marketplaces, has fallen by more than 4.5 million people over the past year, according to a new analysis from the health policy research group KFF. The data shows enrollment dropped from 25.2 million in 2025 to 20.5 million in June 2026, an 18 percent decline—the steepest year-over-year decrease since 2015.
The sharp contraction coincides with the expiration of enhanced premium tax credits that were originally enacted during the COVID-19 pandemic, as well as other policy shifts by the Trump administration. Earlier federal figures had already shown a 12 percent drop in ACA exchange enrollment after Congress allowed the enhanced subsidies to lapse at the end of 2025—the first decline in seven years. The Congressional Budget Office projected in July that exchange enrollment could fall back to pre-pandemic levels as a result of the subsidy loss.
KFF's analysis reveals a steady erosion throughout the year: individual market enrollment was down 16 percent as of March and had fallen 18 percent by June. The individual market is composed mostly of ACA plans. "This drop in enrollment was not completely unexpected," said Justin Lo, a senior researcher with KFF's Program on the ACA and a co-author of the analysis. He pointed to a KFF survey from the start of the year in which 17 percent of enrollees said they doubted they could pay all their premiums for 2026, putting them at risk of losing coverage. "We would also expect that as the year progresses, more people might also be losing their coverage due to not being able to pay their premiums," Lo added.
The June figures do not yet reflect the impact of the Trump administration's recent decision to cancel Obamacare plans for 760,000 people over alleged fraud. That action is expected to further reduce enrollment in the coming months. As lawmakers grapple with the fallout, some Democrats are pushing back with proposals to reverse the cuts and restore subsidies, while others are preparing a broader healthcare offensive if they win the majority.
Despite the steep national decline, one state stands out: New Mexico, which replaced the federal subsidies with its own funding, was the only state where ACA plan enrollment grew. That contrast highlights the role of state-level policy in buffering consumers from federal changes.
While enrollment has fallen sharply this year and premiums have risen, overall individual market enrollment remains about 7 million higher than in 2019, before the enhanced subsidies were introduced. For people in the lowest tax brackets, Lo noted, ACA plans are still relatively affordable. The ongoing debate over healthcare costs continues to dominate the political landscape, with recent polling showing 43 percent support for Medicare for All as voters weigh the issue ahead of the midterms.
KFF's findings underscore the fragility of coverage gains achieved during the pandemic era and the political stakes of subsidy policy. With the Trump administration's fraud-related cancellations still to be reflected in the data, enrollment could fall further in the months ahead. The analysis also raises questions about how many of those who dropped coverage will remain uninsured, and whether states like New Mexico will inspire others to step in with their own funding.
