Affordable Care Act marketplace enrollment slipped for 2026 after temporary federal premium subsidies expired, with about 23 million people selecting coverage in the annual sign-up period that largely ended Jan. 15, down from 24.2 million a year earlier, according to figures cited in a report published Wednesday.
The drop of roughly 1.2 million sign-ups marked the first year-over-year decline in plan selections since a run of record enrollment totals during the period when enhanced premium tax credits lowered monthly premiums for many consumers, according to a report from the Centers for Medicare & Medicaid Services.
Reuters, citing CMS data, reported that fewer than 19.6 million sign-ups were returning customers and that new enrollments totaled nearly 3.4 million.
The enhanced tax credits were created during the COVID-19 era and temporarily expanded premium support for tax years 2021 through 2025, meaning they ended for many consumers as of Jan. 1, 2026, unless Congress renewed them.
The Associated Press has reported that premiums for some subsidized enrollees jumped sharply after the credits expired, and KFF has estimated that premium payments would more than double on average next year without the enhanced credits.
The federal marketplace deadline was Jan. 15, but several state-based marketplaces are keeping open enrollment running through Jan. 31, including California, the District of Columbia, New Jersey, and New York, according to those marketplaces.
Healthcare advocates have warned enrollment could continue to fall as some people who chose plans drop coverage after receiving higher bills.
"Having folks get off the system will derail the entire health care marketplace, especially as more people will unenroll after they receive their first bill," Rep. Adam Smith, D-Wash., said in a statement that also said thousands in his state are uninsured because they "cannot make ends meet."
Congress has continued to negotiate over whether to revive the subsidies.
Sen. Bernie Moreno, R-Ohio, told reporters that Republicans would soon make their "best and final" offer to Democrats regarding the legislation.
Earlier this month, the House passed legislation that would extend the enhanced credits for three years, voting 230-196 on Jan. 8, setting up a Senate fight over how long any extension should last and what, if any, conditions should be attached.
Jim Thomas ✉
Jim Thomas is a writer based in Indiana. He holds a bachelor's degree in Political Science, a law degree from U.I.C. Law School, and has practiced law for more than 20 years.
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