More than five million Americans have dropped Affordable Care Act (ACA), or Obamacare, health insurance plans after enhanced federal subsidies expired, causing a sharp increase in premium costs and reigniting the political fight over former President Barack Obama’s signature health care law.New data released Friday by the U.S. Department of Health and Human Services (HHS) showed that 19.2 million people are enrolled in ACA Marketplace plans for 2026. That’s down from the record of 24.2 million enrolled in 2025, with more than a million fewer people selecting plans during open enrollment and another four million later dropping coverage or failing to pay premiums.The steep declines come after the expiration of enhanced premium tax credits after President Donald Trump and Republicans in Congress refused to extend subsidies introduced during the COVID-19 pandemic under the Biden administration. Democrats had also sought to preserve financial aid and prevent a federal government shutdown in October 2025 during negotiations over extending the program.The Affordable Care Act, widely known as Obamacare after former President Barack Obama, dramatically expanded health insurance coverage after its passage in 2010. Supporters say temporarily increased subsidies have made coverage affordable for millions of people, while Republicans and the Trump administration have argued that the program has become vulnerable to fraud and improper enrollment.According to HHS, current enrollment is 19.2 million. The department report also highlighted concerns over fraud and improper enrollment, saying that efforts by the Trump administration are reducing such cases.However, many health policy experts attributed the decline primarily to rising insurance costs rather than fraud.“The bottom line is that enrollment is down 13% from last year,” said Cynthia Cox, KFF’s program director on ACA. “While the Trump administration credits this decline in enrollment to its efforts to address fraud, this coverage loss occurred at the same time as millions of people faced double or even triple-digit increases in their premium payments with the expiration of enhanced tax credits.”Health policy experts said enrollment is expected to increase between 2021 and 2025 as increased subsidies significantly reduce premium costs.“The market doubled in size during the period when there were increased subsidies because coverage was much more affordable and much more attractive to people,” Cox said.The average premium cost is set to nearly double between 2025 and 2026 after the enhanced tax credits expire, prompting many consumers to leave the market.“When their costs went up, many of them dropped their coverage,” Cox said.Citing arguments made by the conservative Paragon Health Institute, the Trump administration has pointed to fraud as a major reason behind the earlier increase in Obamacare enrollment. However, many independent health care experts dispute that explanation.“I don’t see data that leads to the conclusion that the decline of 5 million people can be explained by fraudulent charges,” said Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms. “There is a lot of evidence that people make decisions based on how much they can afford to pay each month.”Experts said high premiums have also created challenges for insurers. Several companies, including Cigna, have announced plans to withdraw from ACA marketplaces in some areas, citing concerns over less competition and higher prices.“If there are fewer customers, it makes the market less attractive for insurance companies,” Cox said.Healthy individuals are more likely to drop coverage, which could weaken the insurance market over time, he said. However, she does not believe that markets are currently at risk of entering a so-called “death spiral”.“I think there are still enough people buying ACA marketplace coverage and that will keep these marketplaces going,” he said. “At this point, we don’t see any part of the country that is at risk of not having an insurance company. If that were the case, it would look like a death spiral.”Early insurance filings for 2027 indicate that premiums are likely to rise again next year, suggesting that enrollment may continue to decline until Congress revisits financial assistance for ACA policyholders.The issue is expected to become a major health care debate ahead of the November midterm elections, with Democrats accusing Republicans and the Trump administration of allowing the subsidies to expire even as the administration says its crackdown on fraud is improving the integrity of the Obamacare marketplace.