Nearly 5 million Americans have lost health insurance through the Affordable Care Act Marketplace this year after enhanced federal subsidies expired, with new federal data showing that higher premiums led many consumers to forgo or drop coverage.
More than 1 million fewer people enrolled in Marketplace plans for 2026, while another 4 million people either canceled their coverage or stopped paying their premiums, reducing total enrollment from a record 24.2 million people in 2025 to 19.2 million this year.
The subsidies became one of the major issues in the congressional spending debate late last year. Democrats fought to extend the enhanced tax credits, warning that millions of Americans would lose health insurance if premiums rose sharply. Republicans declined to renew the subsidies, allowing them to expire at the end of 2025.
The enhanced subsidies, first approved during the COVID-19 pandemic and later extended, significantly reduced monthly premiums for millions of Americans. Congress allowed those subsidies to expire at the end of 2025.
Premiums Jumped for Many Consumers
The expiration of the subsidies dramatically increased what many Marketplace customers had to pay each month.
While many consumers switched to less expensive plans, health policy researchers estimate that those who remained in the same plan would have faced average premium increases of more than 100% after the enhanced subsidies ended.
Health policy experts say those higher costs are a major reason millions of Americans no longer have Marketplace coverage.
“We know that real people lost their health insurance coverage,” said Cynthia Cox, vice president and director of the Affordable Care Act program at the health policy organization KFF. “This coverage loss happened at the same time millions of people faced double- or even triple-digit increases in their premium payments.”
Kansas Consumers Face Additional Challenge
The loss of coverage may have an even greater impact in Kansas because the state has not expanded Medicaid under the Affordable Care Act.
In states that expanded Medicaid, some lower-income residents who lose Marketplace coverage may qualify for Medicaid instead. In Kansas, many adults who can no longer afford Marketplace plans do not qualify for Medicaid and may have no affordable coverage option.
Kansas consumers also faced higher insurance costs this year. According to the Kansas Health Institute, the average benchmark Silver plan premium for a Kansas family of four increased 28.9% for 2026 — the largest increase since 2019. That increase reflects insurance premium hikes alone and does not include the additional cost many families faced after losing the enhanced federal subsidies.
Middle-Income Families Hit Hard
One of the biggest surprises in the new enrollment data is who was most affected.
Nearly half of the decline in Marketplace enrollment came from households earning more than 400% of the federal poverty level — about $64,000 for an individual or $131,000 for a family of four in 2026.
During the past several years, those middle-income families qualified for enhanced subsidies that lowered their monthly premiums. When the subsidies expired, many lost that financial assistance altogether.
Although they represented only about 7% of Marketplace enrollees, they accounted for 48% of the overall decline in enrollment this year.
Debate Continues
The new enrollment figures have renewed the debate over why Marketplace enrollment fell so sharply.
Democrats argue the numbers confirm what they warned would happen during last year’s budget negotiations: that allowing the enhanced subsidies to expire would make health insurance unaffordable for millions of Americans, forcing many to drop their coverage.
Republican officials point to another factor. They say the Trump administration’s efforts to remove fraudulent and ineligible Marketplace enrollments also contributed to the decline. Administration officials have argued that tighter eligibility verification reduced enrollment by eliminating improper enrollments rather than simply pricing people out of coverage.
Health policy experts say both factors likely played a role but note that the timing of the enrollment decline coincided with substantial premium increases after the enhanced subsidies expired. They also point to evidence that many consumers who remained in the same health plans would have faced premium increases averaging more than 100%, making coverage unaffordable for many households.
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Based on reporting by Community Voice (KS).
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