Enrollment in Affordable Care Act (ACA) marketplace plans and other individual-market coverage fell 18% year over year to 20.5 million in June 2026 from 25.2 million in 2025, according to an analysis by health policy research organization KFF. The decline of more than 4.5 million people was the largest annual drop since 2015 and followed the expiration of enhanced COVID-era premium tax credits at the end of 2025, along with other Trump administration policy changes. Previous federal data showed ACA exchange enrollment had fallen 12% after the subsidies expired, while the Congressional Budget Office forecast in July that enrollment could return to pre-COVID levels. New Mexico, which replaced the federal assistance with state funding, was the only state to record ACA enrollment growth. KFF found that individual-market enrollment, consisting mostly of ACA plans, fell 16% by March and 18% by June. Justin Lo, a senior researcher with KFF's Program on the ACA and a co-author of the analysis, said further coverage losses could occur as enrollees struggle to pay premiums. The June figures exclude an additional decline expected after the Trump administration announced the cancellation of ObamaCare plans for 760,000 people over instances of alleged fraud. Despite the sharp 2026 drop and higher premiums, individual-market enrollment remains 7 million above its 2019 level. For people in the lowest tax brackets, ACA plans remain relatively affordable, Lo said.