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- More than 5 million Americans lost coverage through Medicaid and ACA marketplaces between early 2025 and early 2026.
- States resumed eligibility reviews, driving massive Medicaid and CHIP disenrollments; combined enrollment fell about 18% to roughly 77.7 million by June 2025.
- Enhanced subsidies expired; average monthly premiums rose about $65 and deductibles increased over $1,000, reducing ACA enrollment.
June 26, 2026
The decline follows the expiration of pandemic-era federal policies that expanded health coverage and reduced insurance costs.
More than five million Americans lost health insurance coverage through Medicaid and Affordable Care Act marketplaces between early 2025 and early 2026. This issue is raising concerns about access to care for millions of low- and middle-income households across the United States, NBC News reports.
The decline follows the expiration of pandemic-era federal policies that expanded health coverage and reduced insurance costs. Researchers found that combined enrollment in Medicaid and ACA marketplace plans fell by approximately 5.1 million people nationwide over the past year.
Much of the drop stems from continued Medicaid disenrollments after states resumed eligibility reviews following the end of the federal continuous enrollment requirement on March 31, 2023.
Medicaid and the Children’s Health Insurance Program enrolled about 77.7 million people as of June 2025, down 18% from March 2023 levels, according to KFF. As states completed eligibility redeterminations, millions of beneficiaries were removed from the program.
At the same time, ACA marketplace enrollment declined after enhanced federal premium subsidies expired on Dec. 31, 2025. Open enrollment for 2026 coverage ended with approximately 23.1 million sign-ups, down from roughly 24.2 million a year earlier, according to federal enrollment data.
Health policy analysts say rising costs played a significant role in the enrollment decline. A KFF analysis released May 19 projected that ACA enrollment could ultimately fall by nearly five million people in 2026 as consumers face higher premiums and deductibles.
The report found average monthly premium payments increased by about $65, while deductibles rose by more than $1,000.
“No matter how you slice it, people are paying more,” Cynthia Cox, a KFF vice president and co-author of the analysis, told The Associated Press.
Enrollment losses arrive as lawmakers continue to debate the future of federal healthcare funding and insurance subsidies such as Medicaid. Health policy experts warn that further declines in coverage could increase the number of uninsured Americans, particularly among working families who earn too much to qualify for substantial subsidies yet struggle to absorb higher insurance costs.
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