Obamacare Enrollment Trails 2025 by Less Than Expected

Plan enrollments to date are down by more than 800,000 from 2025, but not nearly by the millions predicted.

An Affordable Care Act sign in front of an insurance agency in Miami on Nov. 12, 2025. Joe Raedle/Getty Images

Plan selections in the Affordable Care Act Marketplace were 3.5 percent behind 2025’s number with two weeks left in open enrollment, but the drop-off has not been as severe as some analysts predicted.

Some 22.8 million people had selected a plan by Jan. 3, which is about 830,000 fewer than at the same point in 2025. The program, popularly known as Obamacare, appears on track for its second-highest enrollment ever.

The open enrollment period began on Nov. 1, 2025, and ends on Jan. 15 in most states. During open enrollment, anyone can sign up for Obamacare. Outside that period, only those who report a qualifying life event such as a birth, divorce, or job change can enroll.

The decline for 2026, if it continues through the final weeks of open enrollment, will mark the first drop in participation since 2020.

Subsidies Boosted Enrollment

From its inception, Obamacare enrollment started more slowly than predicted, taking three years to reach 12.7 million in 2016. From there, enrollment decreased by about 10 percent over four years.

Enrollment was bolstered by enhanced subsidies starting in 2021, and more than doubled to 23.4 million by 2025.

The scheduled expiration of the enhanced subsidies in December 2025 sparked heated debate in Congress as to the affordability of the program without them.

Congressional Democrats sought to make the enhanced subsidies permanent. That effort failed to advance in the Senate despite Democrats’ willingness to withhold federal government funding throughout the fall in an attempt to force negotiations.

The enhanced subsidies were implemented in 2021 as a two-year measure to ensure the affordability of health coverage during the COVID-19 pandemic era. They were later extended through 2025.

Health insurers judged that middle-class Americans who had opted into Obamacare in recent years would opt out again when the subsidies expired, dramatically changing the risk profile of remaining enrollees and shifting it toward those with chronic conditions or higher medical needs.

In response, insurers raised premiums by an average of 27 percent, according to data from health policy research group KFF.

Drop Less Than Predicted

Many observers predicted a huge drop in enrollment in 2026 based on both the decrease in subsidies and the increase in premium costs.

Jason Levitis, senior fellow at Urban Institute, told senators in November that 4.8 million people would lose health coverage in 2026 if the enhanced subsidies expired, based on a report from his organization.

The expiration of the subsidies would “leave millions uninsured or forced to make impossible choices,” according to the Center on Budget and Policy Priorities.

Although the initial 3.5 percent drop of 830,000 enrollees is significant, it does not approach those predictions.

At 22.8 million enrollees, the 2026 figure is 12 percent ahead of 2024 and 43 percent ahead of 2023.

Over the past four years, the number of plan selections increased by an average of 3.7 percent during the final two weeks of open enrollment. In 2025, the increase was 2.4 percent.

On the current track, the number of 2026 plan selections would be the second-highest ever.

Further Decline Likely

Yet some analysts say there will be a further drop after open enrollment closes.

“While we do eventually expect to see declines in Marketplace enrollment, following the expiration of the enhanced premium tax credits at the end of 2025, it is too soon to tell how much it will change,” said Jared Ortaliza, a policy analyst at KFF studying the Affordable Care Act.

The data available now indicate marketplace plan selections that become “effectuated” enrollments when consumers begin paying premiums.

The vast majority of 2026 plan selections so far—20 million—are 2025 customers who were automatically reenrolled in the plan, according to the Centers for Medicare and Medicaid Services.

Those automatic plan selections do not always become premium-paying enrollees, according to Ortaliza.

“The extent of [Affordable Care Act] enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released,” he said.

In 2025, the number of effectuated enrollments was about 4 percent less than the number of plan selections.

Brian Blase, president of Paragon Health Institute, theorized that much of the decline in plan selection, and a likely further decline in effectuated enrollments, is attributable to improper or fraudulent enrollments.

“The decline in enrollment from ’25 to ’26 means that some of the fraudulent enrollment exited the market,” Blase wrote on social media.

Blase estimated that about 5 million enrollments in 2024 and 6.4 million in 2025 were improper, with many being fraudulently enrolled in plans with zero premiums. He said many will disappear as people do not effectuate coverage, which involves paying a premium.

“This means that people who are unaware of their enrollment, in other coverage, or ‘fake’ people will not pay their share of the premium and should (assuming insurers follow the rules) be removed,” Blase wrote.

An effort to reinstate the enhanced subsidies is ongoing in Congress.

Open enrollment in Kentucky and Maine closes on Jan. 16 and in Massachusetts on Jan. 23. Open enrollment closes in California, New Jersey, New York, Rhode Island, Washington state, and the District of Columbia on Jan. 31.