ACA Enrollment Drops 5 Million as Medicaid Losses Mount Nationwide

More than 5 million people lost health coverage through Medicaid or the Affordable Care Act marketplace over the past twelve months, according to newly released federal data and a report published this week by the advocacy group Protect Our Care, as reported by NBC News.

The federal government released ACA effectuated enrollment figures Friday for the 29 states that use the Healthcare.gov marketplace. The numbers confirmed what policy researchers had been projecting since spring: the loss is real, it's large, and it tracks directly with premium costs that doubled for many enrollees after Congress let enhanced premium tax credits expire in December.

"When their costs went up, many of them dropped their coverage," Cynthia Cox, director of KFF's Program on the ACA, told NPR. Cox's team had been tracking this since May. Their analysis, published in May and drawing on CMS data and estimates from Wakely Consulting Group, projected ACA marketplace enrollment would fall from 22.3 million in 2025 to roughly 17.5 million this year, a drop the KFF analysis called "the sharpest single-year drop in raw numbers since the ACA Marketplaces launched."

On the Medicaid side, KFF's enrollment tracker shows 74.3 million people currently enrolled, with Medicaid and CHIP enrollment declining by 4.6 million, or about 6 percent, from April 2025 through March 2026. That decline spans all fifty states. Indiana saw the steepest drop, down 20 percent over that period.

The Protect Our Care report, also cited by NBC News, found ACA plan enrollment fell by more than 10 percent in twelve states, with the largest losses in North Carolina, Ohio, West Virginia, Indiana, and Delaware.

For patients, the numbers aren't abstract. Many didn't choose to leave. They were auto-renewed into plans that became unaffordable once the enhanced subsidies disappeared. "People are trying to hang on to their health insurance coverage any way they can, even if that means they have a deductible of $7,000," Cox told PBS NewsHour. The KFF analysis found that average monthly premiums rose about 58 percent, to $178 from $113 per month, and that many households shifted into higher-deductible bronze plans rather than drop coverage entirely. But millions couldn't make that math work.

Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, told NBC News she sees an additional factor suppressing Medicaid enrollment: a chilling effect among legal immigrants and mixed-status families who are eligible but fear that enrolling could draw immigration enforcement. "The declines," she said, "will get worse once more states implement the Medicaid work requirements."

Those requirements are not yet fully in force. According to NBC News, Nebraska implemented them in May, and Montana is expected to follow next month. For most states, the most consequential Medicaid work requirement provision doesn't kick in until January. CMS released new guidance this month that health policy analysts say makes it harder to qualify for medical exemptions from the work rules.

The Trump administration has attributed part of the ACA drop to anti-fraud efforts. Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, pushed back in comments to NPR: "I don't see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud. There's lots of evidence pointing to people making decisions based on what they can pay each month."

The Congressional Budget Office, cited by NBC News, had projected roughly 15 million more uninsured Americans by 2034 from the combined effect of Medicaid cuts in the 2025 reconciliation law and the expiring subsidies. Researchers and clinicians watching the current numbers say the trajectory is already running ahead of that forecast.

Sources cited:
- NBC News (https://www.nbcnews.com/health/health-news/medicaid-aca-enrollment-falls-5-million-new-report-finds-rcna351157)
- NPR (https://www.npr.org/2026/06/26/nx-s1-5860746/aca-health-insurance-subsidies-rates-premiums)
- KFF, ACA Marketplace Enrollment Analysis (https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/)
- KFF, Medicaid/CHIP Monthly Enrollment Tracker (https://www.kff.org/medicaid/medicaid-enrollment-and-unwinding-tracker/)
- PBS NewsHour (https://www.pbs.org/newshour/health/affordable-care-act-enrollment-projected-to-plunge-by-5-million-as-costs-spike-analysis-shows)