New federal data show that 19.2 million individuals were enrolled in Affordable Care Act marketplace plans as of February, down by nearly 3 million from 2025.
The Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) points to the Trump administration's efforts to reduce fraud and improper signups on the exchanges. However, the timing of the decline also aligns with the end of the enhanced premium tax credits, which drove significant premium increases for marketplace plans.
An analysis of the data drop from KFF said that the enrollment decline represents a 13% decrease from 2025.
Cynthia Cox, senior vice president and director of the Program on the ACA at KFF, noted in the report that the premium tax credits coincided with record enrollment growth and lower premiums for many individuals.
The tax credits expired at the end of 2025 after Congress failed to extend them.
"This is the first time ACA Marketplace enrollment has dropped since the first Trump administration, and it comes on the heels of several consecutive years of rapid growth and record high enrollment that corresponded with enhanced premium tax credits," Cox wrote.
In the ASPE report, regulators said that program integrity efforts under the Trump administration included "mobilizing a full-scale effort to ensure federal subsidies are going only to those for whom they are intended." These efforts prevented about 2.9 million people from receiving subsidies they did not qualify for.
ASPE also said that it estimates "improper, phantom and fraudulent enrollment" in exchange plans reached a peak of 5.6 million in 2025. The agency estimates that about 2.6 million of these enrollments remain, including 1 million people enrolled without a Social Security number.
"The Trump Administration remains committed to aggressively rooting out waste, fraud, abuse and corruption to protect Americans from unscrupulous brokers using their information to secure payments from the federal government and safeguard the program’s long-term stability for those that depend on it," ASPE wrote.
KFF's Cox wrote that enrollment on the exchanges is likely to continue to decline. Previous KFF research projects enrollment could reach an average of 17.5 million by the end of the year,