Enrollment in the Affordable Care Act marketplace has fallen by millions of people this year — and the Trump administration and health policy experts are at odds over the cause.
The number of people enrolled in a health insurance plan bought on the ACA marketplace declined by roughly 3 million people — or, about 13% — to 19.2 million in February 2026 from 22.1 million at the end of 2025, according to data issued last week by the Department of Health and Human Services.
It was the first drop in ACA enrollment since the first Trump administration, and the largest decline since the ACA marketplaces were established in 2014.
The data provided the first look at “effectuated” enrollment since the lapse of enhanced ACA premium subsidies at the end of 2025, which reduced the cost of enrollees’ monthly premiums. The data accounts for whether people who enrolled were also able to make monthly…
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