Analysis estimates up to 12.4 million fewer Americans enrolled in public health coverage since January 2025

Between 10.88 million and 12.40 million fewer Americans were enrolled in a public health coverage program as of June 2026 than in January 2025, according to an analysis published October 8 by the independent analyst Charles Gaba. The figure is a net change in enrollment, and Gaba wrote that it “isn’t quite the same thing as counting how many lost coverage.”

Gaba reported that Medicaid and CHIP enrollment was about 6.22 million lower. He put the decline in Affordable Care Act exchange enrollment at between 4.57 million and 6.09 million, and Basic Health Plan enrollment at about 272,000 lower. Medicare enrollment rose by about 1.76 million, and the total U.S. population rose by about 1.57 million, he wrote, citing Census Bureau monthly estimates.

The data have limits that Gaba described. His figures run through May 2026 for Medicare, Medicaid and CHIP, and through February 2026 for ACA exchange coverage. For March, April and May, he wrote, he included estimated exchange enrollment obtained by extrapolating limited hard data. He wrote that the federal database for exchange enrollment has not been updated since February.

Gaba considered whether people moved to employer coverage and concluded it was “extremely unlikely to account for more than a tiny portion of it.” He also suggested that some people may have moved to short-term or association plans, which he labeled as his guess and for which he provided no data. The analysis does not establish what caused the enrollment declines. It reports changes in enrollment since January 2025.

Costs are rising for people who remain insured. The nonprofit research group KFF reported in October 2025 that insurer charges for ACA marketplace coverage were rising 26 percent on average in 2026. KFF’s analysis said that figure is the insurer premium increase and often is not what enrollees pay.

KFF said 22 million of 24 million marketplace enrollees received a tax credit at that time. It estimated that if the enhanced credits expired at the end of 2025, enrollees’ monthly payments would “more than double, increasing by about 114%, on average.”

Employer plans face increases as well. In an article in Time published October 8, Neale Mahoney, the Trione Director of the Stanford Institute for Economic Policy Research, and Abigail Sanchez, a researcher at the institute, wrote that employer health plan costs are projected to rise 8 to 10 percent next year. They described that as the largest increase in more than 20 years and roughly double the average of the 2010s.

The authors wrote that benefits consulting firms point to more use of care, expensive new drugs, GLP-1 medications, hospital consolidation and AI-assisted billing. They estimated the increase at roughly $400 to $500 more per typical worker.

A Medicaid rule is scheduled to begin soon. According to Mahoney and Sanchez, starting January 1, 2027, the 2025 budget law known as the One Big Beautiful Bill Act requires adults in the 44 Medicaid expansion states and the District of Columbia to document 80 hours a month of work, school or community service.