ACA Enrollment Drops by Nearly 3 Million as Trump Administration and Health Experts Clash Over the Cause

WASHINGTON, D.C. — Enrollment in Affordable Care Act (ACA) health insurance plans has declined by nearly 3 million people in 2026, fueling a growing debate between the Trump administration and healthcare policy experts over what is driving the sharp decrease in coverage.

While federal officials say the decline reflects a successful crackdown on fraudulent enrollments, many independent health policy analysts argue that rising insurance premiums and higher out-of-pocket costs are forcing millions of Americans to give up their health coverage.

Trump Administration Credits Anti-Fraud Measures

Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz have highlighted efforts to eliminate improper enrollments in ACA plans.

According to an HHS report released in June, officials estimated that approximately 5.6 million people were improperly or fraudulently enrolled in Affordable Care Act plans during 2025. The administration says it has removed roughly 2.9 million ineligible enrollees, a figure that closely matches this year's decline in total enrollment.

Federal officials also point to policy changes aimed at strengthening eligibility verification, including ending a Biden-era special enrollment policy that allowed certain low-income Americans to enroll year-round. Since 2025, regulators have also removed individuals who failed to meet tax filing requirements or who were simultaneously enrolled in programs such as Medicaid.

Policy Experts Point to Rising Insurance Costs

Healthcare economists and policy experts dispute the administration's conclusion that fraud accounts for most of the enrollment decline.

Instead, they argue that rapidly increasing insurance premiums and deductibles have made ACA plans unaffordable for many families.

According to data from KFF:

• ACA enrollment declined to approximately 19.2 million people in 2026.
• Average monthly premiums increased to $178, representing a 58% increase compared with 2025.
• Average deductibles climbed 37%, reaching nearly $3,800 annually.

Analysts say these higher costs are likely discouraging many consumers from maintaining coverage.

Matthew Fiedler, a senior fellow at the Brookings Institution, said there is substantial evidence that higher insurance premiums lead consumers to drop their health coverage, making it unlikely that fraud alone explains the enrollment decline.

Healthcare Affordability Remains a Key Political Issue

Healthcare costs are expected to remain a major issue ahead of the upcoming midterm elections, with both major political parties emphasizing different aspects of the debate.

Democrats have generally focused on lowering healthcare costs and expanding affordability, while Republicans have emphasized reducing waste, fraud, and improper government spending.

Recent polling from KFF found that healthcare affordability continues to rank among voters' top concerns. The survey also indicated that many Republican voters place significant importance on combating healthcare fraud, suggesting the administration's messaging resonates with portions of its political base.

Industry Groups Warn Millions May Lose Coverage

Healthcare organizations caution that regardless of the cause, fewer Americans enrolled in ACA plans means more people may now be uninsured.

Annalyse Keller, spokesperson for the coalition Keep Americans Covered, said rising healthcare costs are forcing many households to make difficult financial decisions about maintaining insurance coverage.

Healthcare policy experts also note that while fraud exists within government programs and should be addressed, affordability remains one of the largest challenges facing the individual insurance market.

Looking Ahead

As policymakers continue debating the causes behind declining ACA enrollment, the broader discussion is expected to focus on balancing program integrity with affordable healthcare access. Future legislative decisions on premium subsidies, insurance regulations, and anti-fraud enforcement could play a significant role in determining enrollment trends in the years ahead.