Healthcare.gov Enrollment Plunges by 5 Million
KFF analysis finds Healthcare.gov enrollment plunging 5 million from 22 million in 2025 to about 17 million in 2026 due to expired enhanced premium tax credits.
Objective Facts
According to a KFF analysis released May 19, enrollment in Healthcare.gov and other ACA marketplaces is projected to plunge from 22 million in 2025 to about 17 million in 2026, representing a loss of 5 million enrollees. Most of the 5 million people dropping out of the markets became uninsured rather than finding coverage elsewhere. The primary cause is that enhanced premium tax credits expired at the end of 2025, and although Congress came close to a compromise to extend the extra federal money that helped keep premiums down, the deal fell apart. Last fall, KFF projected that premiums were doubling on average. The average ACA plan deductible saw the steepest increase in history — growing by 37%, or over $1,000, from $2,759 in 2025 to $3,786 in 2026.
Left-Leaning Perspective
Democratic congressional leaders and progressive organizations have consistently called for extending the enhanced premium tax credits. Democrats on Capitol Hill pushed to extend the enhanced federal ACA subsidies, even centering the record-long government shutdown around the issue, though the Republican majority stymied their efforts. The Center on Budget and Policy Priorities argued that a clean extension of the premium tax credit enhancements would be the best outcome for the more than 20 million people whose coverage and costs are hanging in the balance, and there is still time for Congress and President Trump to act if they take this common-sense approach. Democrats emphasize the political and human stakes. 88% of enrollment growth in the ACA marketplace since 2020 occurred in states President Donald Trump won during the 2024 election, according to KFF. The Democratic Congressional Campaign Committee took aim at Rep. Nick Begich for voting against extending the enhanced ACA tax credits, saying premiums have risen 58% on average, and similarly targeted Colorado GOP Reps. Jeff Crank and Gabe Evans for their votes to cut Medicaid and refusal to extend ACA subsidies. Left-leaning coverage emphasizes the human toll and points out what Democrats view as Republican hypocrisy given that the enrollment expansion occurred in Republican-won states. Democratic messaging focuses on the concrete losses—millions losing coverage, premiums doubling, people forced to choose between healthcare and other necessities—while downplaying or omitting Republican arguments about program cost or concerns about fraud.
Right-Leaning Perspective
Republican lawmakers and the Trump administration have opposed extension of the enhanced premium tax credits on multiple grounds. Senate Republicans voted down a three-year extension of enhanced ACA subsidies that Democrats proposed, with Republicans saying they're opposed due to factors like cost and fraud, and have cited an unwillingness to extend a program enacted during the Covid-19 pandemic. Most Republicans in Congress have said they're opposed to extending enhanced subsidies, and White House spokesman Kush Desai said the number of consumers affected by the expiration was a relatively small share of the U.S. population, arguing instead that President Trump is focused on delivering meaningful affordability for every American with his Great Healthcare Plan. Republicans argue the focus should be on structural reform and fraud prevention rather than subsidies. Rep. Nick Begich's spokesperson said that simply extending taxpayer subsidies deeper into the same broken system does not lower the actual cost of care, adding the congressman wants to address the underlying drivers of health care costs, paired with subsidies, while a Crank spokesperson stated that citizenship verification and work requirements for able-bodied adults with no dependents will strengthen and sustain Medicaid for the long term. Those rising costs pose a political challenge for President Trump and the broader GOP, which has opposed enhanced subsidies to help people purchase Obamacare coverage, and Republican lawmakers also passed a spending package that included provisions expected to reduce ACA enrollment and was cited among factors fueling higher premiums this year. Right-leaning coverage emphasizes fraud concerns, program cost, and the argument that the market has stabilized. Republican coverage downplays the enrollment decline as unsustainable fraudulent enrollment being corrected, omits discussion of the political implications for Republicans in red states with large enrollment, and focuses messaging on anti-fraud efforts and alleged inefficiency in the existing system.
Deep Dive
The 5 million enrollment decline represents the first concrete policy consequence of the 2025 subsidy expiration. Enhanced premium tax credits, introduced in 2021 as part of Covid relief and extended through 2025, nearly doubled ACA enrollment from roughly 12 million to over 24 million. The credits allowed lower-income households to afford premiums and also eliminated the income cliff at 400% of federal poverty level, making higher-income workers eligible. When they expired January 1, 2026, the average recipient saw premiums jump from $888 to $1,904 monthly—a more than 100% increase. The political irony is stark: 88% of enrollment growth since 2020 occurred in states Trump won, meaning red-state Republicans face significant political pressure from their own constituents hit hardest by the expiration. Yet the GOP-controlled Congress refused extension efforts, with Republicans citing cost (estimated $150+ billion over 10 years), fraud concerns, and opposition to 'temporary' pandemic-era spending. Democrats argued the subsidy enables market stability and prevents coverage loss, particularly among older, sicker, and lower-income Americans. The House passed a three-year extension in early 2026; the Senate refused to take it up. What each side gets right: Democrats correctly identify that price increases drive coverage loss—basic economics both sides acknowledge. Republicans correctly note that the temporary enhancement created a cliff and that the pre-2021 market was far smaller, raising questions about sustainability. What they omit: Democrats downplay the genuine fiscal cost of permanent extension and the fact that original (non-enhanced) subsidies still exist. Republicans understate the political costs of millions losing coverage in their own districts just before midterms, and ignore that higher-income workers harmed by the cliff—many self-employed or small-business owners—represent their base.