Roughly 5 million people could lose coverage from the Affordable Care Act Marketplace this year after enhanced premium tax credits expired at the end of 2025, according to an analysis released Tuesday by KFF, a health policy research organization.
Last year marked four consecutive years of record enrollment growth in ACA Marketplaces, driven largely by enhanced premium tax credits that made monthly costs more affordable for families. In many cases, plans offered $0 premiums under the expanded subsidy program. However, Congress failed to extend those credits before they expired, and negotiations to revive them have largely stalled.
What the Left Is Saying
Democratic lawmakers and health care advocates say the enrollment decline underscores the consequences of letting subsidies expire without a replacement. Sen. Bernie Sanders of Vermont called for immediate action in a post on social media, writing that Congress must 'renew these credits before millions more lose coverage.' The Progressive Caucus has repeatedly introduced legislation to make the enhanced tax credits permanent, arguing that expanded access reduces overall health care costs by preventing expensive emergency room visits and hospitalizations.
Advocacy groups including Families USA and Community Catalyst say the expiration disproportionately harms low-income families who earn too much to qualify for Medicaid but not enough to afford market-rate premiums without assistance. They point to the 'subsidy cliff' as a structural flaw, where income slightly above the eligibility threshold leaves families responsible for full premium costs that can exceed hundreds of dollars monthly.
What the Right Is Saying
Republicans argue that the enrollment numbers reflect correction rather than crisis. Some conservative economists contend that enhanced subsidies artificially inflated demand and distorted market pricing. Sen. John Cornyn of Texas told reporters that 'marketplace enrollment naturally fluctuates with policy changes' and noted that the previous boost was always intended as temporary pandemic relief.
The White House has emphasized enforcement actions against fraud and improper enrollments, pointing to CMS data showing approximately 1.5 million people were removed from coverage rolls for being ineligible or enrolled without authorization. Critics on the right say the prior enrollment surge included significant numbers of fraudulent or duplicate applications that inflated apparent demand. The Heritage Foundation released a brief arguing that 'fraud remediation' explains much of the enrollment decline independent of premium increases.
What the Numbers Show
KFF estimates 4.8 million to 5.8 million people could lose coverage in coming months as households struggle with higher premiums. Average monthly payments have risen 58 percent, an increase of approximately $65 per month compared to 2025 levels. Enrollment fell by roughly 1.2 million people in the most recent sign-up period, marking the first year-over-year decline since 2019.
Adults aged 18-34 represented the age group with the largest enrollment decrease. Analysts had predicted younger consumers would be most impacted because they are less likely to have employer-sponsored coverage and often qualify for lower subsidies based on income calculations. Marketplace plan selections fell in 41 states, with North Carolina, Ohio, and Indiana seeing among the steepest declines.
Consumers above the 'subsidy cliff' made up just 7 percent of 2025 enrollment but accounted for nearly half of the decline from 2025 to 2026. There are approximately 1 million consumers whose household income remains unknown, meaning the actual share of those affected by subsidy expiration may be higher than current estimates.
The Bottom Line
The expiration of enhanced ACA tax credits has triggered the first enrollment decline in four years, with projections suggesting millions more could lose coverage as 2026 progresses. Policymakers face pressure from both sides: progressives pushing for permanent expanded subsidies, while some conservatives argue market corrections are necessary and point to fraud enforcement as a priority. The gap between Medicaid eligibility and affordable marketplace coverage—known as the subsidy cliff—remains a structural challenge without legislative solution. Watch for fall open enrollment figures and any renewed congressional negotiations on extending or modifying premium assistance programs.