Enrollment in Affordable Care Act (ACA) plans fell by nearly 3 million in 2026 to about 19.2 million, driven by steep premium increases and the Republican-led Congress's reluctance to extend more generous premium subsidies. On average, ACA customers now pay $178 a month in premiums, a 58% increase from 2025, with deductibles rising 37% to nearly $3,800 annually, according to KFF.

The Trump administration credits its fraud crackdown for the enrollment drop, citing a June Department of Health and Human Services report that claims 5.6 million people were fraudulently enrolled in ACA plans in 2025 and that 2.9 million were removed—matching the 2026 enrollment decline. The administration has tightened enrollment processes to prevent brokers from fraudulently signing up individuals without their knowledge.

However, policy experts dispute this explanation. Matthew Fiedler, senior fellow at the Brookings Institution, called the claim that all enrollment decline since 2025 is due to fraudulent enrollees "not remotely credible." Annalyse Keller, spokesperson for Keep Americans Covered, emphasized that "these are real people who are now forced to make impossible choices" due to rising costs.

A poll found that 55% of Republican voters consider addressing healthcare fraud extremely important, indicating some success in the administration's focus shift from costs to fraud concerns.

Each flagged consumer account identified by the administration reportedly used a sales broker, enrolled in a zero-premium plan, and lacked a Social Security or immigration documentation number—a sign of potential fraud noted by Kennedy in a video. Yet, missing Social Security numbers could also result from simple oversights or newborns added before receiving their numbers.

The conflicting views highlight the complexity behind the ACA enrollment decline, with rising costs and fraud both playing roles in the current healthcare landscape.

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