Individual Market Health Insurance Enrollment Fell 18 Percent in One Year, KFF Finds
A drop of 4.7 million enrollees between 2025 and June 2026 marks the largest single-year decline on record for the individual market, raising questions about the policy and affordability factors...
Individual health insurance enrollment in the United States fell from 25.2 million people in 2025 to 20.5 million in June 2026, a loss of approximately 4.7 million enrollees and an 18 percent decline, according to an analysis published by KFF, a nonprofit health policy research organization. KFF's analysis, cited by The Hill, identified the drop as the largest year-to-year decrease since tracking of the individual market began following enactment of the Affordable Care Act in 2010.
The individual market includes plans purchased through federal and state exchanges established under the Affordable Care Act, commonly referred to as ObamaCare, as well as off-exchange individual plans purchased directly from insurers. Both categories are reflected in the KFF enrollment figures.
The decline coincides with the expiration of enhanced premium tax credits that were first enacted under the American Rescue Plan Act of 2021 and subsequently extended through 2025 by the Inflation Reduction Act of 2022. Those subsidies reduced net premiums for millions of enrollees, particularly those with incomes between 100 and 400 percent of the federal poverty level. Whether Congress passed any further extension prior to the June 2026 data snapshot is a matter of legislative record; the status of any such extension would be found in enrolled bill text and Congressional Budget Office cost estimates published by Congress.
The Centers for Medicare and Medicaid Services, which administers the federal HealthCare.gov exchange, publishes monthly enrollment snapshots that would show the state-by-state breakdown of where enrollment fell most sharply. Those reports are available on the CMS website and would identify whether declines were concentrated in states using the federal platform or in states operating their own exchanges.
For context, individual market enrollment stood at approximately 10.6 million in 2016, the first full year after ACA exchange subsidies were fully operational, according to CMS historical data. Enrollment climbed significantly after 2021 when enhanced subsidies took effect, reaching its peak of 25.2 million in the 2025 plan year. The June 2026 figure of 20.5 million, while lower than the 2025 peak, remains substantially above pre-enhanced-subsidy levels.
The financial consequence for enrollees who left the market without obtaining employer-sponsored or public coverage is unknown from the KFF analysis alone. It is not established in the published data how many of the 4.7 million departed enrollees transitioned to Medicaid, gained employer-sponsored insurance, or became uninsured. The Census Bureau's Current Population Survey and its annual Health Insurance Coverage report, typically published in the fall, would provide the most comprehensive estimate of uninsured rate changes attributable to this period.
Insurers operating in the individual market are required to file annual financial data with state insurance commissioners and with the National Association of Insurance Commissioners. Those filings would show premium revenue changes, medical loss ratios, and profitability trends for each carrier participating in the exchanges, and would clarify whether the enrollment drop was accompanied by adverse selection that altered the risk pool.
On the legislative side, the House Energy and Commerce Committee and the Senate Finance Committee both have jurisdiction over ACA subsidy policy. Hearing records and markup documents from both committees in the 119th Congress would show what, if any, legislative action was considered in response to the subsidy cliff. Those records are publicly available through congress.gov.
The KFF analysis does not attribute the enrollment decline to any single cause. Possible contributing factors identified in the health policy literature include the end of enhanced subsidies, premium increases by insurers, administrative barriers during open enrollment, and outreach funding reductions at the federal level, but the relative weight of each factor is not established by the KFF data alone.
What remains unknown is the precise uninsured count resulting from the enrollment drop, the state-level distribution of losses, and whether any corrective legislative or regulatory action was taken before June 2026. The documents that would answer those questions are the CMS monthly enrollment snapshots, the Census Bureau health insurance report, NAIC carrier filings, and enrolled legislation from the 119th Congress.