Average monthly premiums for Affordable Care Act health plans more than doubled in a single year, and roughly 2.6 million Americans stopped being enrolled — but the fight over why that happened may matter more than the numbers themselves.
Story Snapshot
- Enhanced ACA subsidies expired January 1, 2026, and average monthly premiums jumped from $888 to $1,904 — a 114% increase.
- The Kaiser Family Foundation projects total ACA enrollment will fall from 22.3 million in 2025 to about 17.5 million in 2026, a 27% drop.
- The Trump administration’s Health and Human Services department says the entire decline came from removing fraudulent or “phantom” enrollees — not sticker shock.
- Both explanations have data behind them, and the real answer likely involves both — but the political stakes are enormous either way.
Premiums Doubled and Millions Left the Market
When Congress let the enhanced Affordable Care Act (ACA) subsidies expire at the end of 2025, the math for millions of Americans changed overnight. The Kaiser Family Foundation (KFF) estimates average monthly premiums jumped from $888 to $1,904 — a 114% increase in one year.
People earning between 400% and 500% of the federal poverty level were hit hardest. That income group saw a 44% drop in enrollment, the steepest of any bracket, which lines up almost perfectly with where the subsidy cliff cuts off.
Ohio and Oklahoma each lost about 32% of their ACA enrollees over the past year — the largest state-level declines in the country. States using the federal marketplace saw roughly a 21% drop overall.
The Congressional Budget Office projects enrollment could fall further, to 12.5 million by 2028 — nearly half of 2025 levels — if nothing changes. Those are not small numbers. They represent real people making hard choices about whether a $1,900 monthly premium is worth it.
The Government’s Counter-Argument: Fraud, Not Affordability
Here is where the story gets complicated. The Department of Health and Human Services (HHS) released a report in late June 2026 with a very different explanation.
Its Office of the Assistant Secretary for Planning and Evaluation (ASPE) concluded that the entire 2.9 million enrollment decline came from removing improper and phantom enrollees — not from people dropping coverage because they couldn’t afford it.
The report identified roughly one million enrollees who lacked valid Social Security numbers and estimated 2.6 million more improper enrollments remained even after cleanup.
Obamacare rolls shrank dramatically in many states over the past year, new federal data shows — via @AP https://t.co/jwHD2STpFA
— STAT (@statnews) July 6, 2026
The Paragon Institute, a conservative health policy group, backed that conclusion directly, stating the data shows the decline reflects fraud removal, not subsidy lapse. That framing is politically useful for the Trump administration, which has been skeptical of the subsidies’ value.
Republicans have argued the enhanced subsidies cost about $300 billion over a decade and inflate overall healthcare costs. The Committee for a Responsible Federal Budget has made similar arguments. If the drop is mostly about cleaning up fraud, the case for renewing subsidies weakens considerably.
Why the Fraud Explanation Does Not Fully Add Up
The fraud argument has real evidence behind it — but it leaves some important questions unanswered. KFF’s income-level data showing a 44% drop specifically among the group just above the subsidy cutoff is hard to explain through fraud removal alone. Fraudulent enrollees do not tend to cluster neatly at one income bracket.
Ohio and Oklahoma’s 32% state-level declines also remain unexplained if fraud removal was the uniform national cause. And there is an internal numbers problem: HHS’s own ASPE report claims 2.9 million removals, but Centers for Medicare and Medicaid Services data shows only a 1.4 million enrollment decline — a gap that nobody has fully reconciled.
Some of the people who left ACA plans likely returned to employer-sponsored coverage rather than becoming uninsured. That matters. A drop in ACA enrollment is not automatically a coverage crisis if workers moved to a job-based plan. But for the self-employed, early retirees, and workers at small businesses without benefits, there is no employer plan to return to.
For those people, a $1,900 monthly premium is simply not a realistic option. The honest answer is that both subsidy sticker shock and fraud cleanup contributed to the decline — and pretending it was only one or the other serves a political argument, not the public.
What Comes Next and What It Costs
Congress has not passed a subsidy extension. Democratic senators have pushed for one, but no unified plan has moved forward. The longer negotiations drag on, the more people make permanent decisions — dropping coverage, skipping care, or going without.
The CBO’s projection of 12.5 million enrollees by 2028 assumes no policy change. That trajectory would represent one of the largest rollbacks of health coverage in the ACA’s history. Whether you think the subsidies were good policy or expensive overreach, the data makes one thing clear: when the money stopped, people left.
Sources:
forbes.com, facebook.com, cnbc.com, kff.org, urban.org, abcnews.com
