The decline in enrollment in the Affordable Care Act (ACA), popularly known as Obamacare, has been attributed to several factors, including a significant increase in premiums.
In 2026, enrollment fell to approximately 19.2 million, representing a decrease of nearly 3 million. This decline has been supported by claims from the Trump administration related to enrollment fraud.
These conflicting positions of experts and the Trump administration have opened a diatribe on the matter, which stings and spreads.
Diatribe on the mat
The Trump administration argues that the drop in enrollment is a consequence of its efforts to combat fraud, noting that 5.6 million enrollments were considered fraudulent in 2025. However, this approach has been questioned by health policy experts, who argue that rising prices are the driving factor behind the drop in enrollment.
Analysts suggest that although the ACA has fraud problems, the administration's allegations may be exaggerated. Several studies cite rising premiums and deductibles as the primary causes of many people abandoning their health plans. Experts also find that the message of focusing on fraud may be diverting attention from a broader problem of medical costs.
According to KFF, on average, ACA beneficiaries pay $178 a month in premiums this year, a 58% increase from 2025, while their deductibles have increased 37%, to nearly $3,800 a year.
“These are real people who are now forced to make impossible decisions,” said Annalyse Keller, spokesperson for Keep Americans Covered, a large coalition of health care lobbying organizations, which includes insurers and patient advocacy groups, reports CBS News.
On the other hand, the Republicans put their hypothesis on the table. They point out that Democrats, led by President Joe Biden, passed the law in Congress that included more generous tax subsidies for people enrolled in Obamacare, starting in 2021. These improved subsidies reduced premiums, and millions of people were able to access a tax credit large enough to completely eliminate their monthly payment, KFF reports. The Biden-era law also allowed higher-income households to receive assistance, CBS News reports.
According to the Department of Health and Human Services (HHS) report, Affordable Care Act (ACA) coverage nearly doubled, going from just over 11 million Americans in 2021 to more than 22 million in 2025.
And this is where Republicans and conservatives shout to the heavens. They warn that this growth was not only due to new registrations due to lower premiums, but also that interested factors led to fraud.
Debate on the eve of elections
The debate over the ACA intensifies ahead of the November midterm elections, with Democrats and Republicans attempting to capitalize on voters' concerns about health care costs.
Despite efforts by the administration to focus attention on fraud control, recent surveys show a general distrust of these claims and increased concern about rising health care costs.
