Nearly 23 million Americans now get health insurance through Affordable Care Act marketplaces, but new data shows enrollment has started to slip as enhanced federal subsidies expire, according to a Pew Research Center analysis released this week.
Pew reports that about 22.8 million people selected an ACA exchange plan for 2026, down from 24.3 million a year earlier, marking the first major drop since Congress expanded subsidies in 2021.
The decline follows the expiration of enhanced premium subsidies at the end of 2025. Those subsidies lowered monthly costs and expanded eligibility, and the Congressional Budget Office estimates that letting them lapse will leave 4.2 million more people uninsured by 2034.
The ACA exchanges serve people who do not qualify for Medicaid and lack access to affordable employer-sponsored insurance. In 28 states, the federal government runs the exchanges through HealthCare.gov, while 22 states and Washington, D.C., operate their own.
Enrollment surged after subsidies expanded during the pandemic, rising from about 10.5 million before 2020 to more than double that level. Even so, Pew notes that only about 6.9% of the U.S. population relies on ACA exchanges, compared with far larger shares covered by Medicare or Medicaid.
Most exchange plans fall into four tiers based on cost-sharing: Bronze, Silver, Gold, and Platinum. Silver plans dominate enrollment, accounting for more than half of all selections, in part because they qualify for additional cost-sharing assistance for lower-income enrollees.
The main financial support comes through premium tax credits, which reduce monthly insurance costs. As of early 2025, more than 93% of exchange enrollees used these credits, and they covered about 83% of the average premium under the expanded system.
With the enhanced subsidies gone, required household contributions have jumped. Pew’s analysis shows that some families will see monthly premiums double, depending on income and location, reversing much of the affordability gained since 2021.
The federal government spent more than $100 billion annually on ACA marketplace subsidies in recent years, according to figures cited in the report. Critics have raised concerns about cost and fraud, while supporters argue the subsidies are central to keeping coverage affordable.
Pew’s report concludes that the future of the ACA exchanges now hinges on whether Congress revisits subsidy levels, as higher costs are expected to push more Americans out of the insurance market.
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