CounterPunch Exclusives

CounterPunch Exclusives

2.6 Million Americans Lost Health Insurance in 2025 After ACA Subsidies Expired, Leading to Real Health Consequences

Photo: Jeffrey St. Clair.

Millions of Americans who buy their own health insurance coverage through the Affordable Care Act marketplaces faced a stark choice this year: pay more than twice as much to keep the same plan or go without. Many did not keep their coverage.

Federal data released on June 26, 2026, shows that marketplace enrollment fell from 21.8 million people in February 2025 to 19.2 million in February 2026, a decline of about 2.6 million people, or 12%. That is the steepest single-year decline since the marketplaces opened in 2014. ACA marketplaces (or exchanges) are government-regulated platforms where individuals and small businesses can shop for and purchase compliant private health insurance.

As a health economist who studies how insurance coverage affects people’s health, I see the drop as more than a numbers story. The key question is: What happens to people’s health when coverage becomes too expensive to keep?

The drop in enrollment numbers traces back largely to the expiration of the ACA’s enhanced premium tax credits, which lowered enrollees’ monthly payments when they were in effect from 2021 through 2025.

Those subsidies, enacted during the COVID-19 pandemic to make marketplace coverage more affordable, more than doubled marketplace enrollment between 2020 and 2024. But when they lapsed at the end of 2025, the average subsidized enrollee’s cost to keep the same plan jumped about 114%.

Many people switched to cheaper, higher-deductible plans, but average premium payments still rose 58% and deductibles climbed 37%, or more than US$1,000 per person.

By February 2026, only 83% of people who selected a marketplace plan had paid their premiums and kept their........

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