Enrollment in Affordable Care Act (ACA) plans fell by nearly 3 million in 2026 to 19.2 million, according to federal data. The Trump administration attributes the decline to its enforcement of fraud controls, while policy experts cite steep premium increases and reduced subsidies as primary drivers.
The Department of Health and Human Services (HHS) reported in June 2025 that 5.6 million people were fraudulently enrolled in ACA plans, with 2.9 million removed by the administration—matching the enrollment drop. The administration halted a Biden-era policy allowing year-round sign-ups and removed 1.5 million people for reasons including tax filing non-compliance or dual enrollment in Medicaid.
Premiums and Deductibles Rise
Average monthly premiums for ACA customers reached $178 in 2026, a 58% increase from 2025, while deductibles climbed 37% to $3,800 annually, according to KFF. The Republican-led Congress did not extend enhanced premium subsidies, contributing to affordability challenges.
Policy Changes and Enforcement Actions
The administration cited fraud prevention as a key reason for the enrollment decline. In August 2025, it ended a policy allowing low-income individuals to enroll outside the annual open enrollment period. Regulators also removed enrollees for failing to meet tax filing requirements or being concurrently enrolled in other health programs.
Industry and Advocacy Group Response
A coalition of healthcare industry groups, including insurers and patient advocates, criticized the enrollment drop. Annalyse Keller, a spokesperson for Keep Americans Covered, stated, "These are real people who are now forced to make impossible choices." The group argues that affordability, not fraud, is the primary driver of the decline.
Background on ACA Enrollment Trends
The ACA, enacted in 2010, has faced fluctuating enrollment since its implementation. Fraud concerns have periodically surfaced, though most experts agree such issues are not unique to the ACA. The program’s structure relies on a mix of federal subsidies, state participation, and individual mandates to maintain coverage levels.
Ongoing Debate Over ACA’s Future
The enrollment decline has intensified debates over the ACA’s sustainability. Supporters of the law argue that rising costs and policy changes disproportionately affect low-income enrollees, while critics contend that fraud controls are necessary to protect taxpayer-funded programs. The administration’s enforcement actions remain a point of contention among policymakers.