5 Million Dropped ACA Coverage in 2026 as Both Sides Claim Their Explanation Is Right

The HHS released enrollment data Friday covering the 29 states that use Healthcare.gov, and the picture is stark.

5 million people gone. Enrollees either disenrolled or never paid premiums after signing up for 2026 ACA plans, according to the HHS report published Friday. Cynthia Cox, director of KFF's Program on the ACA, summarized it plainly in comments reported by NPR: "The main takeaway is that enrollment is down 13% from last year."

Neither side is wrong on the underlying facts. The question is weight.

What the Trump Administration Says

HHS, in a report obtained by Fox News Digital, says fraudulent enrollment peaked at an estimated 5.6 million people in 2025. The administration says it has already removed nearly 3 million improper enrollees and has 2.6 million more flagged, including over 1 million without a Social Security number. About 19.2 million people remain on ACA rolls as of the report's figures.

The administration's theory, aligned with analysis from the Paragon Health Institute, is that a Biden-era loosening of eligibility checks created the conditions for mass abuse. According to HHS, the Biden administration relaxed income verification requirements, expanded year-round enrollment windows, and allowed brokers to enroll people without their knowledge — what the administration calls "phantom enrollments." The alleged result: enrollment ballooned from 10 million when Biden took office to a peak of 22 million in 2024, and the administration estimates the abuse cost taxpayers roughly $10 billion between 2021 and 2024.

Those are the administration's estimates, attributed to internal HHS analysis. They have not been independently audited and represent the government's own characterization of its own crackdown.

What Health Economists Say

The strongest counterargument is simple and grounded in policy history. Congress passed enhanced premium tax credits during the pandemic. Enrollment nearly doubled. Congress let those credits expire. Premiums, on average, doubled from 2025 to 2026, according to NPR's reporting. Enrollment collapsed.

"The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people," Cox told NPR.

Democrats attempted to extend the enhanced credits and triggered a government shutdown in October 2025 in the effort. That extension did not happen. When costs rose, people left.

Cox and Georgetown Center on Health Insurance Reforms senior research fellow Stacey Pogue are skeptical that fraud accounts for 5 million departures. "I don't see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud," Pogue told NPR. "There's lots of evidence pointing to people making decisions based on what they can pay each month." Fraud is real in insurance markets, Cox acknowledged, but she does not believe it scales to 5 million people.

Where the Two Framings Diverge

NPR's framing leans on the premium cost explanation and treats the fraud narrative as primarily a politically motivated theory from a conservative think tank. Fox News presents the fraud crackdown as a clear success, largely bypassing the premium expiration as a driver of the enrollment drop. Both outlets are covering the same HHS report from the same week. Each is accurate on the facts it chooses to emphasize. Neither gives the reader the full picture on its own.

Fraud in the ACA markets is real and documented. The administration has produced specific figures and named specific abuses, including phantom broker enrollments and income misrepresentation. Those are not fabrications. At the same time, a near-doubling of average premiums is a textbook explanation for why people stop buying something. Attributing 5 million departures entirely to fraud cleanup, when premiums also doubled, requires more evidence than the administration has presented publicly.

What Is Actually Known vs. Alleged

Proven by sourced evidence: ACA enrollment fell by approximately 5 million for 2026. Premiums roughly doubled for many enrollees after enhanced tax credits expired. The Trump HHS has removed approximately 3 million enrollees it designates as improper, with 2.6 million more flagged.

Alleged but not independently verified: The $10 billion fraud figure comes from internal HHS estimates, not a completed audit or court finding. The 5.6 million peak fraudulent enrollment figure is an administration estimate.

The system design makes this genuinely hard to disprove. Because the ACA marketplace relies on self-reported income, and because verification was relaxed under the Biden-era rules, the true scope of improper enrollment may not be knowable without a full forensic audit that has not been completed.

What Comes Next

The remaining 2.6 million flagged enrollees face potential removal. If the administration moves on those, total ACA enrollment would fall below 17 million, a level not seen since before the enhanced subsidy era. Early insurance rate filings for 2027 show that rates will be going up again next year, according to analysis from Pogue at Georgetown. Whether any form of premium support survives ongoing congressional debate will determine whether the 5 million who left 2026 coverage have any realistic path back in.