Enrollment in Affordable Care Act plans fell by nearly 3 million in 2026, dropping to about 19.2 million as the Trump administration said its fraud crackdown had cleared millions of improper names from the rolls. But the numbers now sit at the center of a sharper fight: whether the loss of coverage was really driven by fraud enforcement or by higher bills that pushed people out of the market.
That argument matters now because the 2026 plans came with an average premium payment of $178 a month, up 58% from 2025, while average deductibles climbed 37% to nearly $3,800 a year. For people buying coverage through the market, those costs arrived all at once, and for many there was no easy way to stay enrolled.
The Department of Health and Human Services said in a June report that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and the Trump administration said it removed 2.9 million of them. Regulators also said they had removed 1.5 million people since 2025 for reasons that included failing to file taxes over two years or being enrolled at the same time in another health program such as Medicaid. The administration has used those figures to argue that the enrollment drop reflects cleanup, not a loss of coverage.
Policy experts say that explanation does not match the scale of the decline. Matthew Fiedler said the top-level claim that all of the enrollment loss since 2025 came from improper or fraudulent enrollees leaving the market was not remotely credible. He said people drop coverage when premiums rise, and this year’s premium jump was steep enough to do exactly that. The administration halted a Biden-era initiative in August 2025 that allowed low-income people to sign up for coverage year-round, adding another barrier for anyone trying to keep or regain insurance.
Annalyse Keller, who has watched the impact on customers, said these were real people who were now forced to make impossible choices. That is the part of the dispute that the raw enrollment figures do not settle: even if some people were removed because they should not have been counted, the size of the decline cannot be explained by fraud alone. The more immediate answer is that higher premiums and deductibles made ACA coverage harder to keep, and the unresolved question is how much of the loss came from enforcement and how much came from price.
The political fight over that split is already feeding into the healthcare debate now, and it leaves the administration with a harder task than citing fraud numbers. It must show that the people who vanished from the rolls were actually removed for fraud, not simply priced out of coverage.
