“This coverage collapse was a choice that Congress made. As a result, millions more will end up uninsured, living sicker, dying younger, and being one emergency away from financial ruin.”
House Speaker Mike Johnson (R-La.) speaks during a news conference in the US Capitol on March 17, 2026.
(Photo by Bill Clark/CQ-Roll Call, Inc via Getty Images)
Jake Johnson
Jun 29, 2026
COMMON DREAMS
The Trump administration quietly released data last week showing a sharp decline in the number of Americans enrolled in health insurance on the Affordable Care Act exchanges, a widely predicted outcome caused by congressional Republicans’ refusal to extend subsidies that helped people buy coverage.
The new data, published Friday on the Department of Health and Human Services’ website, shows that 19.2 million people were enrolled in ACA marketplace plans as of February—a decline of more than 5 million since the start of President Donald Trump’s second term.
Last year, Republicans repeatedly blocked Democratic efforts to enact a temporary extension of the enhanced ACA tax credits, whose expiration at the start of 2026 led insurers to jack up premiums, pricing many out of coverage entirely. In focus groups, some Americans facing premium spikes said they would be forced to cut back on groceries or ration their medications to afford coverage.
“This dramatic decrease of millions of Americans losing health insurance is the result of deliberate decisions by the president and congressional leaders—it is what we feared but expected, given the end of the enhanced tax credit and other policies that make it harder to get on and stay on coverage,” said Anthony Wright, executive director of the advocacy group Families USA. “As a result, millions more will end up uninsured, living sicker, dying younger, and being one emergency away from financial ruin.”
Wright dismissed the Trump administration’s attempt to explain away the coverage losses by claiming the numbers show a decline in “phantom” enrollment and fraud, calling that narrative “an insult to every person who became uninsured or underinsured.”
“These results are real for the millions who faced premiums doubling, paying hundreds of thousands of dollars for coverage. The resulting price spikes and coverage losses are real for all who buy coverage as individuals, including gig workers, small business owners, young adults, seniors not quite of Medicare age, and many others,” said Wright. “The consequences are now undeniable: millions dropped from the rolls, and yet another year of double-digit premium increases.”
The lapse of enhanced ACA subsidies—which were established in 2021 during the Biden administration—alongside the roughly $900 billion in Medicaid cuts included in the Republican budget package that Trump signed into law last summer amounts to what analysts, advocates, and Democratic lawmakers say is the largest assault on federal healthcare programs in US history.
“We weren’t being hysterical. We knew this would happen,” said Rep. Sara Jacobs (D-Calif.) in response to the new enrollment figures. “When Republicans passed the Big Ugly Bill and cut funding for healthcare, they literally signed away millions of Americans’ ability to afford health insurance. And now it’s happening.”
According to the Congressional Budget Office, around 16 million people across the US could lose health coverage by 2034 due to the Trump-GOP law, and millions of children have lost coverage since last year.
“Trump and Republicans are engineering the most devastating assault on healthcare in history, and today’s numbers prove it,” Leslie Dach, chair of the advocacy group Protect Our Care, said on Friday. “They ripped away the tax credits that helped millions afford coverage, gutted funding to help people enroll, and sabotaged the ACA at every turn. They knew exactly what would happen, they chose to do it anyway, and it’s going to get worse.”
“Among the three million who have lost coverage are parents skipping cancer screenings, patients rationing insulin, and families who are now one medical emergency away from financial ruin,” said Dach. “Republicans created this crisis on purpose, and while Americans pay for it with their health and their lives, billionaires are cashing their tax cut checks.”
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