About 3 million fewer Americans held Affordable Care Act health insurance in February than a year earlier, the Department of Health and Human Services reported Friday, the first official federal accounting of what happened to enrollment after enhanced premium subsidies expired on Jan. 1.
The 13 percent drop, from 22.1 million enrollees in February 2025 to 19.2 million this year, captures the marketplace after the grace period for missed first-bill payments closed. KFF, the nonpartisan health research group, projects the total will keep falling to roughly 17.5 million by year-end, which would mark the steepest year-over-year decline since the program opened for business.
What the data show
The figures were compiled in April and reflect coverage in February. A federal estimate in January had already shown about 800,000 fewer sign-ups during open enrollment than a year earlier, the first down year at that stage of the shopping window in four years. Friday's report is the first to measure how many of those who did sign up failed to pay and lost coverage. The expired subsidies were the subject of a bitter fight in Congress last fall, with Democrats and some Republicans calling for their renewal; after the Jan. 1 lapse, KFF said, consumers faced double or even triple digit increases in their premium payments.
The Cox finding
"We know that real people lost their health insurance coverage," said Cynthia Cox, a vice president and director of the ACA program at KFF, citing survey findings on people who had dropped their plans. "This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments."
ACA plans have in recent years become a common route to coverage for gig workers, farmers, ranchers, hairstylists and others who do not have insurance through an employer and do not qualify for Medicaid.
The HHS account
HHS in Friday's report attributed much of the loss to a federal crackdown on "phantom" enrollments — people signed up fraudulently by brokers without their knowledge. Outside analysts cited in both the Associated Press and The Hill accounts said the dominant driver was unaffordability after premiums spiked, not fraud cleanup. No HHS official was quoted by name in either wire account defending the fraud explanation.
The counterpoint
HHS's own framing — that the enrollment drop reflects a cleanup of fraudulent sign-ups rather than a coverage loss — is the principal on-record dissent from the subsidy-expiration story, and it is the department's official position in Friday's report. It is not, however, the view that dominated outside commentary on the data; the analysts quoted Friday uniformly tied the decline to price. Neither Democratic nor Republican congressional offices were quoted in Friday's reporting, leaving the political response to the figures, on a Friday in late June, largely unspoken on the record.
The November midterm elections are five months away, and voters consistently rank affordability among their top concerns.