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Enrollment in plans under the Affordable Care Act (ACA) dropped by three million people between 2025 and February 2026, according to data from the Department of Health and Human Services released by The Associated Press, marking the largest reduction recorded in the subsidized insurance market since the program's inception.
The official figures indicate a 13% drop in coverage: from 22.1 million members in 2025 to 19.2 million in February of this year.
The federal government attributed part of the decline to a campaign against fraudulent or "phantom" enrollments, but analysts in the healthcare sector point to a more direct cause: the expiration, on January 1, 2026, of enhanced federal subsidies that have kept premiums affordable for millions of families since 2021.
Cynthia Cox, vice president and director of the ACA program at the health research organization KFF, was emphatic in assessing the data: "We know that real people lost their health insurance coverage. This loss of coverage occurred while millions of people faced increases of two or even three digits in their premium payments."
The Kaiser Foundation estimated that, without the enhanced subsidies, the average premium payment out of pocket for enrollees could more than double by 2026, with an increase of 114%: from about $888 per year in 2025 to around $1,904 this year.
Cox also warned that the decline is not over: KFF projects that enrollment could continue to fall throughout the year, reaching a low of 17.5 million people, which would represent a cumulative loss of almost five million insured compared to the peak of 22.3 million recorded in 2025.
Florida is the state most affected by the impact. With 4.7 million enrollees in 2025, of which nearly 97% received some form of subsidy, and without having expanded Medicaid, the ACA marketplace serves as the only avenue for many low-income workers, freelancers, and small businesses to access health insurance.
The subsidies that have now expired were the focal point of a heated political dispute in Congress during the fall of 2025. Democrats and some moderate Republicans called for their renewal, but unsuccessfully.
The Cuban-American congress members from Miami, María Elvira Salazar, Mario Díaz-Balart, and Carlos Giménez voted against extending the subsidies and declined to join the bipartisan effort to renew them, despite Democratic leader Hakeem Jeffries publicly warning that "hundreds of thousands of people in South Florida" were at risk.
On January 12, the House of Representatives approved legislation to extend subsidies for three years, with a vote tally of 230 to 196, including 17 Republicans joining the Democrats. However, the three Cuban-American congressmen were not part of that group, and the subsidies had already expired.
As an alternative, President Trump introduced in January his Great Health Plan to replace Obamacare, which proposes to return funds directly to citizens so they can purchase their own insurance and reduce medication prices by between 80% and 90%.
However, the plan has not yet been approved by Congress and leaves key questions about coverage for individuals with pre-existing conditions unanswered.
With the legislative elections approaching in November 2026, analysts anticipate that the rising cost of health insurance will become one of the central topics of the campaign, at a time when healthcare affordability tops voters’ concerns.
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