The most affordable health insurance many Americans had ever found is suddenly out of reach.
The coverage cliff
Enrollment in Affordable Care Act marketplace plans fell about 13 percent in the first two months of 2026 — from 22.1 million in 2025 to 19.2 million by February — and could slide to an average of about 17.5 million by year's end, according to a KFF analysis. The trigger was the expiration, on January 1, of the enhanced premium tax credits first created in 2021 and later extended through 2025; Congress did not renew them. For people who kept the same plan, premiums rose an average of 114 percent, KFF found; even those who switched to cheaper plans paid 58 percent more on average, and deductibles climbed by more than $1,000 per person.
Who is squeezed
The sharpest pain falls on middle-income people who earn too much for Medicaid but have no coverage through a job — gig workers, the self-employed, farmers and small-business owners who came to rely on the marketplace over the past decade. The enhanced credits had capped what these households paid at 8.5 percent of income and extended help above four times the poverty line; without them, many now face bills that eat a far larger share of their pay. In a KFF survey of returning enrollees, nearly three-quarters said they were worried about affording emergency or hospital care, and 44 percent said the higher costs were cutting into money for food, utilities or rent.
A dispute over the cause
The Trump administration has attributed much of the enrollment drop to a crackdown on fraudulent sign-ups — cases in which brokers allegedly enrolled people without their knowledge. Health-policy analysts largely agree some cleanup of the rolls was warranted, but argue the timing — the decline lines up almost exactly with the premium spike — points to affordability as the main driver, ABC7 reported. The two explanations are not mutually exclusive, but they carry very different political implications heading into the fall.
The California angle
California runs its own marketplace, Covered California, long among the nation's largest and most stable, and it had posted record enrollment in recent years with the help of the enhanced federal credits. With those gone, Californians who earn too much for Medi-Cal but lack job-based coverage face the same premium shocks hitting consumers elsewhere; the state's own supplemental subsidies may soften the blow for lower-income enrollees but will not fully replace the lost federal help. State officials have urged Washington to restore the credits.
A fight without a resolution
Democrats in Congress have pushed to revive the enhanced subsidies, calling the coverage losses a backdoor weakening of the ACA; some Republicans have voiced unease about a rising uninsured rate before the November midterms, but no deal has emerged. Unless Congress acts, analysts warn, the uninsured rate — which had fallen to a record low — could give back several years of progress by the end of 2026.
