Why It Matters
Roughly 5 million Americans lost or dropped their Affordable Care Act marketplace coverage between 2025 and 2026, a development with direct implications for healthcare access, hospital finances, and the broader insurance market. Georgia residents, like those in 28 other states served by the federal Healthcare.gov marketplace, were directly exposed to the premium increases that followed the expiration of enhanced financial assistance.
What Happened
A report released Friday by the Department of Health and Human Services showed that ACA marketplace enrollment fell to 19.2 million in 2026, down from a peak of 24.2 million the prior year. That represents a 13 percent year-over-year decline — the steepest single-year drop in the program’s history.
The primary driver, according to analysts, was the expiration of enhanced premium tax credits that had been in place during the COVID-era years and extended through 2025. When those credits lapsed, average premiums roughly doubled for many enrollees. Of the 5 million who left coverage, more than 1 million did not select any plan for 2026, while approximately 4 million either formally disenrolled or lost coverage after failing to pay their premiums.
Republicans in Congress chose not to renew the enhanced financial assistance during budget negotiations. Democrats attempted to leverage a government funding standoff in October 2025 to force an extension of the credits, but that effort did not succeed.
Adding further uncertainty to the market, Cigna announced it will not participate in ACA marketplaces in the coming year, a withdrawal that could limit plan options for consumers in parts of the country.
By the Numbers
- 19.2 million — current ACA marketplace enrollees in 2026
- 24.2 million — peak enrollment in 2025
- 5 million — net enrollment decline year over year
- 13% — percentage drop from 2025 to 2026
- ~2x — average premium cost increase following credit expiration
- 29 states — relying on Healthcare.gov as their ACA marketplace
Competing Explanations
The Trump administration has attributed the enrollment decline at least in part to efforts to combat fraud and clean up ineligible enrollees from the marketplace rolls. The administration has pointed to past reporting of auto-enrollment irregularities as inflating prior enrollment figures.
Independent health policy analysts dispute that framing. Cynthia Cox of KFF acknowledged the administration’s fraud argument but drew a direct line to premium costs: “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments with the expiration of enhanced tax credits.”
Stacey Pogue of the Georgetown Center on Health Insurance Reforms went further, saying she does not see data supporting the idea that fraud enforcement alone could account for a loss of that scale. “I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud,” she said.
Zoom Out
The expiration of enhanced ACA subsidies has been a contentious policy question at the federal level for several years. The credits were originally enacted as a temporary pandemic-era measure and later extended through the Inflation Reduction Act. Their lapse in 2026 marks the first time since their introduction that millions of lower- and middle-income consumers have had to purchase marketplace coverage without that added assistance.
Insurer exits from ACA markets are not new — major carriers pulled back from many markets in the program’s early years — but Cigna’s announced departure signals continued instability in the marketplace structure at a critical moment. Consumers in affected states may face fewer plan choices during the next open enrollment period.
For more on healthcare and insurance policy developments, see our coverage of the FDA panel’s unanimous backing of Moderna’s mRNA flu vaccine and a look at how one life insurance company is linking healthy habits to policyholder incentives.
What’s Next
Congress has not announced any legislative action to revive the enhanced premium tax credits. Advocates for the program are likely to push for reinstatement during future budget or reconciliation negotiations. Open enrollment for 2027 marketplace plans is expected to begin later this year, and the coverage landscape will depend heavily on whether any new subsidies are enacted before that window opens.