根据健康研究组织KFF的分析，过去一年，奥巴马医改及其他个人市场健康保险计划的参保人数减少了超过450万人。参保人数从2025年的2520万人降至2026年6月的2050万人，下降了18% — — 这是自2015年以来最大的年度降幅。这一下降与新冠疫情期间增强型保费税收抵免的到期以及特朗普政府的其他政策变化同时发生。
Enrollment in ObamaCare and other health insurance plans on the individual market dropped by more than 4.5 million people over the past year, according to an analysis by health research organization KFF. Enrollment fell from 25.2 million in 2025 to 20.5 million in June 2026, an 18 percent drop — the largest year-to-year decrease since 2015. The decline coincides with the expiration of COVID-era enhanced premium tax credits as well as other Trump administration policy changes.
此前的联邦数据显示，在国会于2025年底让增强型补贴到期后，平价医疗法案（ACA）交易平台的参保人数下降了12%，这是七年来的首次下降。国会预算办公室在7月预测称，由于增强型补贴的流失，ACA交易平台的参保人数可能降至疫情前水平。新墨西哥州是唯一一个用自身资金取代联邦补贴的州，也是唯一一个ACA计划参保人数增长的州。
Previous federal data showed that, after Congress let the enhanced subsidies expire at the end of 2025, enrollment in the Affordable Care Act (ACA) exchanges fell 12 percent, the first decrease in seven years. The Congressional Budget Office forecast in July that, due to the loss of the enhanced subsidies, ACA exchange enrollment may fall to pre-COVID levels. New Mexico, the one state that replaced the federal subsidies with its own funding, was the only state where enrollment in ACA plans grew.
KFF发现，个人市场（主要由ACA计划组成）的数据显示，截至3月参保人数下降了16%，截至6月下降了18%。KFF的ACA项目高级研究员Justin Lo（同时也是该分析的合著者）表示：“这一参保人数的下降并非完全出乎意料。”Lo指出，KFF在年初进行的一项调查发现，17%的参保人认为他们可能无法支付2026年的全部保费，这使他们在今年某个时间点面临失去保险的风险。
Data on the individual market — which is comprised mostly of ACA plans — suggests enrollment fell 16 percent as of March and 18 percent as of June, KFF found. “This drop in enrollment was not completely unexpected,” said Justin Lo, a senior researcher for the KFF's Program on the ACA at KFF, who also co-authored the analysis. Lo noted that a survey KFF conducted at the start of the year found 17 percent of enrollees thought they would not be able to make all their premium payments for 2026, which put them at risk of losing coverage at some point this year.
“我们也预计，随着一年的推进，由于无法支付保费，可能会有更多人失去保险，”Lo说。6月的数据未计入特朗普政府最近宣布的因涉嫌欺诈而取消76万人奥巴马医改计划所导致的参保人数下降预期。
“We would also expect that as the year progresses, more people might also be losing their coverage due to not being able to pay their premiums,” Lo said. The June figures do not account for the drop in enrollment expected from the Trump administration’s recent announcement that it is cancelling ObamaCare plans for 760,000 people due to instances of alleged fraud.
虽然今年的注册人数大幅下降，保费也有所增加，但总体注册人数仍比2019年（即引入增强型补贴之前）多了七百万人。对于处于最低税率档次的人群，罗表示，ACA计划仍然相对负担得起。
While enrollment has fallen sharply this year and premiums have increased, overall enrollment is still up by seven million from 2019, before the introduction of the enhanced subsidies. For people in the lowest tax brackets, Lo said ACA plans are still relatively affordable.