Enrollment in the Affordable Care Act (ACA) health insurance plans has decreased by more than 1 million individuals following the expiration of enhanced tax credits that previously made coverage more affordable. As of January 15, 2026, nearly 23 million people were enrolled in ACA plans across the United States. This figure includes those using the federal platform as well as those in states with their own exchanges.
The significant drop in enrollment highlights the financial strain many will face as premiums for ACA plans are projected to increase sharply. According to the Kaiser Family Foundation (KFF), individuals making $35,000 could see their annual premiums for a benchmark plan rise from $1,033 to approximately $2,615—a nearly $1,600 increase. This surge follows the lapse of subsidies first introduced under the American Rescue Plan in 2021 and extended through the Inflation Reduction Act of 2022.
Many experts anticipate further declines in enrollment in the coming months. Haeder, a health policy researcher, remarked that the current drop may only represent the beginning. He noted that existing customers were automatically re-enrolled in their plans if they did not take action to opt out. However, new regulations imposed by last year’s legislation will require individuals to actively manage their enrollments, potentially leading to more people inadvertently losing coverage.
The overall number of returning customers stands at 19.5 million, a decrease of about 4.6 million from the previous year. Haeder indicated that many individuals may have retained their plans, hoping for a legislative extension of the enhanced tax credits. As bills for the upcoming months arrive, it is likely that a new wave of disenrollment will occur. Insurance providers may also begin to cancel coverage for individuals who do not pay their premiums for several months, leading to a potential final spike in disenrollment around April.
The implications of these changes could be profound. Individuals who are generally healthy may drop their coverage to save money, while those with existing health issues may choose to maintain their plans. Haeder pointed out the potential risks associated with this shift, particularly for those who could face serious health issues without insurance. He emphasized the upcoming pressure on healthcare providers, especially in states that have not expanded Medicaid, such as Texas and Florida.
The loss of insurance coverage could force individuals to delay seeking medical care, which may lead to more serious health crises down the line. As Haeder stated, “People had health insurance, now they don’t have health insurance. They might not come in when they have a cold. But if something really bad happens to them, they will still be in.” This shift could create additional burdens on healthcare systems, particularly in rural areas where access to services is already limited.
As the situation evolves, stakeholders are calling for renewed discussions about extending the enhanced subsidies to mitigate the adverse effects of rising premiums. The ongoing challenges highlight the complexities of healthcare policy in the United States and the critical importance of affordable access to health insurance for millions of Americans.
