The Centers for Medicare and Medicaid Services (CMS) reported Wednesday that 23 million people signed up for open enrollment, which concluded on Jan. 15. It marks a drop-off from the 24.2 million people who enrolled for insurance during the same period in 2025.
Earlier figures had already indicated a drop in enrollment, with 22.8 million people having signed up by mid-January, just a few days before the final Jan. 15 federal deadline to sign up for an ACA Marketplace plan.
According to the CMS, there were 19.6 million returning customers for this year, compared to the 20.2 million returning customers in 2025.
These latest figures mark the official end to a four-year streak of record high enrollments seen under the Biden administration, largely credited to the enhanced premium tax credits.
The final figures are still subject to change. Some states and territories have extended open enrollment deadlines, with California, Illinois, D.C., New Jersey, New York, Pennsylvania and Rhode Island maintaining open enrollment until Jan. 31.
But health care advocates have warned that enrollment could likely continue to drop as enrollees may lose their coverage after being unable to afford the higher premiums this year.
"Having folks get off the system will derail the entire health care marketplace, especially as more people will unenroll after they receive their first bill," Rep. Adam Smith (D-Wash.) said in a statement this week, noting thousands in his home state are now uninsured because they "cannot make ends meet."
Talks to revive the subsidies are ongoing, with Sen. Bernie Moreno (R-Ohio) saying Republicans would soon be making their "best and final" offer to Democrats.
"It's going to be in the hands of the Democrats very shortly. … Here's the exact thing that we think is the maximum we can sell our conference," Moreno told reporters.
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