Almost 4 million people who had Affordable Care Act health insurance plans this year have ended their coverage, the Trump Administration announced on Friday night.
The drop was not unexpected, but it was still substantial. When the administration and Congress failed to renew the Affordable Care Act’s income-based subsidies dating from the beginning of the Covid pandemic last year, costs for health insurance premiums went sharply higher, doubling and even tripling premiums for some Americans. This almost certainly was the primary cause for the drop in enrollment.
The figures released by the Department of Health and Human Services said that 19.2 million people were enrolled in A.C.A. plans as of February. That’s a significant drop from the 23 million who signed up for A.C.A. coverage in the open enrollment period; apparently some people signed up but did not pay the higher premiums.
Health costs have consistently ranked among the top concerns Americans have cited in public opinion polls recently, surpassing even events like immigration, the Iran war, rising gas and food costs, and other issues. This suggests that health costs could be a big factor in the midterm elections this fall.
Ripple effects
The drop is expected to have ripple effects throughout the healthcare system. People who are uninsured will delay or end healthcare, and they will get sicker from delaying care. This will add to burdens throughout the healthcare system.
Hospitals and other providers who had benefited from the boost in insured people from the Affordable Care Act and the covid-era subsidies will see their income cut back. Medicaid rolls may boom — but the administration’s stated plan to cut Medicaid as of Jan. 1, 2027, will mean more people will find that path unavailable, along with the Medicaid work requirements and the re-certification of Medicaid eligibility.
The administration’s report on Friday spent a lot of time talking about fraudulent A.C.A. enrollment. There has been no proof of widespread fraudulent enrollment, but the administration continues to suggest that that is true.
“Due to temporary legislative changes and regulatory approaches that reduced program integrity safeguards, from 2021 to 2024, the ACA Exchanges saw unprecedented enrollment growth, nearly half of which was suspected to be improper, phantom, or fraudulent,” the H.H.S. statement said, without offering evidence.
“Enrollment that is improper or fraudulent is enrollment by individuals misstating their income to gain access to free plans. Phantom enrollees are unknowingly enrolled in free plans by brokers or auto enrolled. By our estimate, improper, phantom and fraudulent enrollment peaked at 5.6 million people in 2025.
“Currently, an estimated 19.2 million Americans are enrolled in ACA Exchange plans. This figure is higher than every year prior to 2024.
“The Trump Administration has utilized numerous tools mobilizing a full-scale effort to ensure federal subsidies are going only to those for whom they are intended.”
