Affordable Care Act coverage plunges in 2026: Questions and answers

Congress surprised and disappointed healthcare leaders when they didn’t extend tax credits supporting the Affordable Care Act, and now there is more information about how many people have dropped coverage.

Here’s a quick rundown on the drop in Americans getting health insurance under the Affordable Care Act.

Q: How many people dropped coverage nationally?

A: Around 2.6 million fewer Americans had coverage under ACA plans in February 2026 compared with the same time last year, according to an Associated Press analysis. The AP analyzed federal data from the Centers for Medicare & Medicaid Services.

Q: What has led to the drop?

A: The enhanced tax credits supporting the Affordable Care Act expired at the end of December. Congress didn’t extend them as expected, even as hospitals and healthcare groups urged lawmakers to preserve the tax credits.

Analysts had projected that millions would be dropping coverage, because without the subsidies, premiums were projected to double. Some Americans simply couldn’t afford the higher premiums.

Even some Americans who can manage the higher costs may be opting to drop coverage, especially if they’re younger and healthy, Drew Corrigan, KPMG’s U.S. Sector Leader for Healthcare, told Chief Healthcare Executive® earlier this year.

Federal officials said in a June report that some of the drop is tied to cracking down on fraudulent or “phantom” enrollment.

Q: Which states are seeing the biggest drops in coverage?

A: Florida has more people covered under ACA plans than any state. In terms of sheer numbers, Florida saw the biggest drop with more than 440,000 fewer residents covered.

Mary Mayhew, president and CEO of the Florida Hospital Association, told Chief Healthcare Executive® last month that she was worried about even bigger reductions over the next year.

“We could see between 750,000 and a million Floridians lose coverage because of that dependency on those enhanced premium tax credits,” Mayhew said.

In terms of percentages, Ohio and Oklahoma led the nation, as each state saw enrollment drop by more than 32%, the AP found. Eight other states saw enrollment in ACA plans drop by more than 25%: Arizona, South Carolina, Minnesota, Indiana, Michigan, Mississippi, Louisiana and Missouri.

Q: What does this mean for hospitals?

A: Hospitals are expecting to see more patients without any health insurance.

The Florida Hospital Association recently did a survey of its members, and respondents said inpatient admissions of patients without insurance rose by more than 20% in the first quarter of 2026, compared to last year, Mayhew said.

Those without insurance often end up seeking care in hospital emergency rooms, said Rick Pollack, president and CEO of the American Hospital Association. And that’s likely to lead to more emergency room crowding.

“We're talking about an increased number of people that are either going to be uninsured or underinsured,” Pollack told Chief Healthcare Executive in February.

“We are the ultimate safety net where people turn to and that's going to have a real dramatic impact, again, not just on the people that are affected by these policies, but on everyone.”

Q: What is the financial impact on hospitals?

A: Health systems are feeling more financial pressure. HCA Healthcare, the nation’s largest hospital system, said this week that it is seeing more patients without insurance, mainly from those losing coverage on the health insurance exchanges.

HCA said the impact before taxes was about $400 million in the second quarter. HCA expected to take a hit, but the losses were more than the system anticipated. The company now projects the impact of lost coverage to be $1 billion this year, or more.

Hospitals with higher portions of patients relying on ACA plans for coverage are going to face more difficulties this year, Fitch Ratings projects.

Q: What about cuts in Medicaid?

Hospitals are also dreading reductions in Medicaid that are slated to occur over the next decade. Medicaid spending is expected to be reduced by nearly $1 trillion over initial projections, and millions are expected to lose coverage.

Jennifer DeCubellis, president and CEO of America’s Essential Hospitals, has said the Medicaid cuts could force some safety net hospitals to reduce services or shut down.

“More and more hospitals and healthcare systems, in particular, essential hospitals, are in trouble right now,” DeCubellis said in an interview with Chief Healthcare Executive last winter.