Millions Dropped Obamacare in the First Month of Coverage

Four million Americans dropped out of Affordable Care Act insurance marketplaces in their first month of coverage this year, largely for failing to pay monthly premiums.

The decline — far larger than in previous years — reflects the sticker shock felt by millions as premiums rose by double digits after congressional Republicans allowed for extra pandemic-era federal subsidies to expire in December.

Marketplace enrollment remains far higher than before the COVID-19 pandemic, but Democrats are likely to seize on the figures released Friday to blame Republicans for higher health care costs ahead of the midterms.

Around 19.2 million people were enrolled in the marketplaces as of February, down from 23.1 million who selected a plan during the 2026 open enrollment period, according to a report posted online Friday by the Office of the Assistant Secretary for Planning and Evaluation, or ASPE, at Health and Human Services.

The current enrollment declines could be significantly higher than the February figures the Trump administration released Friday, as marketplace plans can start kicking people off coverage starting in April if they haven’t paid.

It’s normal for some enrollees to drop out of the marketplaces once premiums are due, but this year’s attrition is higher than usual. Enrollment declined by roughly 400,000 people over the same time period in 2025, leaving 22.3 million people enrolled in the marketplaces over the course of that year.

The figures released Friday confirmed previous reporting by NOTUS that enrollment declined significantly.

Democrats seeking House and Senate majorities this year have adopted health care affordability as a top message. It has been such a salient issue for Democrats that their congressional caucus shut down the government over demands to extend the enhanced subsidies. In a political flip, they’ve been the ones blaming the GOP for high ACA costs — although it was Democrats who passed President Barack Obama’s health care bill in 2010 without a single GOP vote.

The law created the marketplaces to make plans available to people without access to employer-sponsored coverage, Medicare or Medicaid. Under its original design, people 400% below the federal poverty level can collect subsidies to help them afford plans.

Republicans late last year refused to renew the extra subsidies, which helped further lower monthly premium payments for the vast majority of marketplace customers during and right after the pandemic.

Most enrollees can still get the original subsidies provided through the law, but many middle- and higher-income customers were left ineligible after the boosted subsidies expired. Unsubsidized customers faced a double whammy as insurers hiked premiums by double digits.

Even with the attrition, far more Americans remain in the ACA marketplaces than before the pandemic, when 11 million people used them to buy health insurance.

The Trump administration is attributing some of the decline to fraudulent enrollments, which was a problem during the pandemic as agents and brokers gamed the system to sign up people who weren’t eligible or enroll them multiple times.

“By our estimate, improper, phantom and fraudulent enrollment peaked at 5.6 million people in 2025,” the ASPE report says.

Insurers have presented some early signs they intend to keep hiking prices next year.

They’ve proposed double-digit premium increases in 10 of the 11 states that have released preliminary 2026 filings, according to an analysis by Charles Gaba, who has analyzed the marketplaces for years on his website ACASignups.net. Thirteen health insurers in Washington state’s marketplace have requested premium increases of 22% on average.