Three million fewer people in the United States held Affordable Care Act health insurance plans in February compared to the same time last year, according to new federal data. This 13% drop in enrollment, from 22.1 million people in 2025 to 19.2 million this year, represents a direct transfer of healthcare costs from the state to working-age individuals, bolstering the private insurance sector.
The U.S. Department of Health and Human Services attributed the decline to a federal crackdown on fraudulent or “phantom” enrollment.
However, health analysts stated the coverage loss was more likely related to the Jan. 1 expiration of federal subsidies, which caused a surge in plan costs and left many unable to pay their premiums.
Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, confirmed that “real people lost their health insurance coverage.”
Cox added that “This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments,” indicating a significant increase in surplus extraction from the working class.
Who Pays the Price
The new data, compiled in April but reflecting coverage in February, provided the government’s first official look at the impact of nonpayment after a grace period expired.
A federal estimate released five months ago, in January, had already shown about 800,000 fewer people signed up for ACA plans compared to the previous year, marking the first enrollment decline in the past four years at that point in the shopping window.
KFF expects the total number of people in the government healthcare program to continue to decline throughout the year, potentially reaching a low of about 17.5 million, according to Cox.
This projected decline would be a significant reduction for the government’s flagship subsidized health insurance program, which primarily serves working-age people who do not qualify for Medicaid.
The report noted that ACA plans have become a popular choice for precarious workers, including gig workers, farmers, ranchers, hairstylists, and others without health coverage through an employer, highlighting the vulnerability of this segment of the labor force to rising costs.
The State's Role in Cost Shifting
The ACA subsidies that expired nearly six months ago were the subject of a bitter fight in Congress less than one year ago, last fall.
Despite calls for their renewal from Democrats and some Republicans, the state allowed these subsidies to lapse, effectively shifting the burden of healthcare costs back onto individuals and away from public funding.
This action, or inaction, by the state serves to protect the accumulated wealth of the private healthcare industry by ensuring continued revenue streams through increased individual premiums.
Sharp increases in health costs across ACA and other health insurance programs persist as voters, facing approaching November elections, identify affordability as a top concern.
This ongoing crisis demonstrates how reform efforts within the existing system, such as the ACA, offer temporary gains that are easily reversed, failing to address the fundamental structural issue of healthcare being treated as a commodity rather than a right.