Democrats spent much of 2025 reminding Republicans about a looming deadline: Without congressional action, tens of millions of American consumers would lose their existing subsidies under the Affordable Care Act and face dramatic spikes in their healthcare coverage. This, Democrats warned, would in turn force many families simply to give up and go without insurance.

As last year came to an end, congressional Republicans nevertheless chose not to act. The ACA insurance subsidies that Democrats created during Joe Biden’s presidency were allowed to expire at midnight on Dec. 31.

For those involved in the healthcare debate, the question was less about whether Americans would choose to forgo coverage and more about how many. With this in mind, NPR reported:

Far more people than previously known have dropped Affordable Care Act health insurance for 2026, according to data released Friday.

Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high reached last year. More than 1 million fewer people picked a plan for 2026, and then 4 million more either disenrolled or failed to pay their premiums and therefore dropped coverage.

I’m mindful that different news organizations have published reports looking at the same data but have pointed in slightly different directions. The Associated Press, for example, reported that roughly 3 million fewer people “had Affordable Care Act health insurance plans in February compared with the same time last year.” The Hill, meanwhile, reported that about 4 million Americans “have dropped out of Affordable Care Act insurance coverage this year.”

These reports are all accurate, though they’re counting in slightly different ways. The NPR report’s tally, however, captures the context in a straightforward way: Federal data shows enrollment in the ACA marketplace reached 24.2 million people in 2025, and now that total is 19.2 million people.

Republican officials don’t deny the accuracy of the data, although they have repeatedly tried to argue that the reduction is a positive development. The Trump administration has had great success in cracking down on fraud and ineligible enrollees, the argument goes, which is why the overall enrollment total has fallen.

There’s reason to be skeptical of the GOP’s official line.

Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, told the AP, “We know that real people lost their health insurance coverage. This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments.”

In other words, people dropped their coverage when Republicans allowed prices to soar to levels consumers could no longer afford.

Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms, similarly told NPR, “I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud. There’s lots of evidence pointing to people making decisions based on what they can pay each month.”

It didn’t have to be this way. This was a deliberate policy choice made by Republican officials who had an opportunity to leave a better alternative in place.

This post updates our related earlier coverage.

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