Healthcare Enrollment Plummets After Federal Premium Subsidies End
By Jim Thomas | Thursday, January 29, 2026
Affordable Care Act marketplace enrollment for 2026 dropped to approximately 23 million people after temporary federal premium subsidies expired. The annual sign-up period ended on January 15, down from 24.2 million in the previous year, according to Centers for Medicare & Medicaid Services (CMS) data.
The decline of roughly 1.2 million sign-ups marks the first year-over-year decrease in health insurance enrollment since a streak of record numbers occurred during periods when enhanced premium tax credits lowered monthly premiums for many consumers. CMS reports that fewer than 19.6 million were returning customers, with new enrollments totaling nearly 3.4 million.
The enhanced tax credits, implemented during the COVID-19 era and extended through tax years 2021 to 2025, ended for most consumers on January 1, 2026, unless Congress renewed them.
Healthcare advocates warn that enrollment may continue to fall as individuals drop coverage following sharp premium increases after the credits lapsed. KFF estimates average premiums would more than double next year without these enhanced credits.
While the federal marketplace closed on January 15, several state-based marketplaces remain open through January 31, including California, the District of Columbia, New Jersey, and New York.
“Having folks get off the system will derail the entire health care marketplace, especially as more people will unenroll after they receive their first bill,” Rep. Adam Smith (D-Wash.) stated in a recent comment. Smith also highlighted that thousands in his state remain uninsured due to financial difficulties.
Congress has been actively negotiating an extension of the subsidies. Sen. Bernie Moreno (R-Ohio) said Republicans would soon make their “best and final” offer to Democrats regarding legislation to revive the credits.
Earlier this month, the House passed a bill extending enhanced credits for three years by a vote of 230-196 on January 8, setting up a Senate debate over the duration and conditions of any extension.
Jim Thomas is a writer based in Indiana. He holds a bachelor’s degree in Political Science and a law degree from U.I.C. Law School, with over 20 years of legal practice experience.
