The Affordable Care Act (ACA) has faced a substantial decline in enrollment this year, with over 3 million individuals opting out of their health insurance plans. This shift comes amidst a surge in monthly premiums and the expiration of enhanced subsidies that previously made these plans more affordable.
The U.S. Department of Health and Human Services (HHS) reported that as of February 2026, approximately 19.2 million people were enrolled in an ACA plan, down from 23.1 million in January 2026 and 24.2 million in January 2026. The expiration of the enhanced ACA subsidies at the end of 2026 has significantly increased the cost of insurance for millions of consumers.
The Impact of Rising Premiums
The expiration of the enhanced subsidies has led to an average cost increase of 114% for ACA enrollees in 2026, according to KFF, a health policy nonprofit. This dramatic rise in premiums has made health insurance unaffordable for many Americans. Sabrina Corlette, codirector of Georgetown University’s Center on Health Insurance Reforms, noted that “when you raise prices for a good or service, fewer people are going to buy it.” This principle is clearly evident in the current health care landscape.
Private health insurers and the nonpartisan Congressional Budget Office had anticipated significant enrollment drops due to the increased costs. Cynthia Cox, vice president and director of the program on the ACA at KFF, stated that the enrollment drop was “really isn’t surprising” given the circumstances. The number of people who “effectuate” enrollment by making a monthly payment dropped from 22.1 million in 2026 to 19.2 million in February 2026.
Fraud and Improper Enrollments
The HHS report also highlighted efforts to crack down on improper signups, citing that nearly half of the ACA enrollment growth from 2026 to 2026 was “suspected to be improper, phantom or fraudulent.” The Trump administration’s efforts blocked the enrollment of 2.9 million people who were “improperly receiving subsidies they did not qualify for.” However, experts believe that affordability remains the primary reason for the drop in enrollment.
A KFF survey found that 17% of enrollees were not confident that they could afford their health insurance premiums for all of 2026. Additionally, a Georgetown Center on Health Insurance Reforms report published in June 2026 suggests that health insurers will likely raise rates again next year. Insurers in nine states and Washington, D.C., sought rate increases for 2027 coverage ranging from 6.5% in Vermont to 22.4% in Washington state.
The Broader Implications
The decline in ACA enrollment has broader implications for health care access and affordability. In South Carolina, for example, over 100,000 residents lost their health insurance coverage due to Medicaid cuts and the expiration of ACA subsidies. The Protect Our Care advocacy group reported that more than 5 million people nationwide have lost their health coverage since June 2026.
The Trump administration has justified these changes by citing widespread fraud in the ACA enrollment process. However, health care experts have questioned the methodology of the studies supporting these claims. The administration argues that tighter eligibility verification is necessary to protect the programs from fraud and misuse.
Despite these efforts, the reality remains that millions of Americans are struggling to afford health insurance. The Protect Our Care data shows that average ACA marketplace premiums in South Carolina have risen by 235% since 2026, with some households facing even steeper increases. This affordability crisis is pushing more people to drop their coverage, leaving them vulnerable to health care costs and potential financial instability.
