About 3 to 5 million Americans dropped ACA health insurance coverage in early 2026 after federal enhanced subsidies expired on January 1, causing premiums to spike beyond what many enrollees could afford. This represents one of the sharpest enrollment declines in ACA history — driven by sudden cost increases rather than improved access to alternative coverage. The Trump administration blamed fraud; health policy experts pointed to the subsidy loss as the primary driver. The scale matters: millions of people who had insurance are now uninsured, which shifts costs to emergency care systems and reduces preventive care access.