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2026 ACA Enrollment Decline Is Small While Improper Enrollees Remain

5AW ACA Enrollment Decline A0wUU000004zl9NYAQ
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Mark Howell Headshot SMALLER V2

Mark Howell is a Research Assistant at Paragon Health Institute. He is passionate about advancing free-market solutions to improve healthcare access and affordability.

Brian Blase

President at Paragon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and served as its CEO.

The Centers for Medicare and Medicaid Services released 2026 open enrollment period (OEP) data showing a modest decline in ACA marketplace enrollment, with total sign-ups down by 1.3 million (5.5 percent) from 2025). This PIC shows OEP enrollment from 2014 through 2026 and includes Paragon’s estimates of improper enrollment in 2024 (5.0 million) and 2025 (6.4 million).

It is not yet clear how much of the 2026 decline reflects a reduction in improper and phantom enrollment versus individuals choosing to drop their ACA plans. Even so, the overall decline is relatively small. This is likely due to automatic re-enrollment, inflated subsidy levels, and aggressive silver-loading practices (as discussed in this Paragon Prognosis).

5AW ACA Enrollment Decline A0wUU000004zl9NYAQ

The Centers for Medicare and Medicaid Services released 2026 open enrollment period (OEP) data showing a modest decline in ACA marketplace enrollment, with total sign-ups down by 1.3 million (5.5 percent) from 2025). This PIC shows OEP enrollment from 2014 through 2026 and includes Paragon’s estimates of improper enrollment in 2024 (5.0 million) and 2025 (6.4 million).

It is not yet clear how much of the 2026 decline reflects a reduction in improper and phantom enrollment versus individuals choosing to drop their ACA plans. Even so, the overall decline is relatively small. This is likely due to automatic re-enrollment, inflated subsidy levels, and aggressive silver-loading practices (as discussed in this Paragon Prognosis).

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Mark Howell Headshot SMALLER V2

Mark Howell is a Research Assistant at Paragon Health Institute. He is passionate about advancing free-market solutions to improve healthcare access and affordability.

Brian Blase

President at Paragon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and served as its CEO.