A new federal report shows that most people who recently signed up for health insurance through the ACA marketplace got plans with zero monthly premiums. That was because the government was paying their insurance costs in full through a temporary subsidy program. But that program is set to expire at the end of 2025, which means those people will suddenly have to start paying for insurance — sometimes for the first time.

About 23.1 million people signed up for ACA plans for 2026 through HealthCare.gov. That number is near an all-time high. It stayed that high mainly because of the subsidy program that made insurance free for a large group of enrollees.

Who Will Be Hit Hardest

When the subsidies expire, the people who got free insurance will face the biggest cost shock. Jumping from paying nothing to paying something — even if it is only a few hundred dollars a year — makes people think differently about keeping their insurance. For people making less money, who made up most of the people getting free plans, that jump is often enough to drop their coverage entirely.

The government studied how many people got health insurance because of these subsidies between 2021 and 2024. That number will matter for measuring what happens next. The latest report shows that enrollment stayed high through the recent open enrollment period, even though everyone knew the subsidies would expire.

What the Trump Administration is Proposing

President Trump has said he wants to replace the subsidy system with direct payments to people instead. But the administration has not said how much people would get, who would qualify, or exactly how it would work. It is also not clear whether Congress will pass a new plan before the current subsidies expire.

Timing is a real problem. Insurance companies decide what to charge for plans every year, and they need to know the rules well before people start signing up in the fall. If Congress has not passed a new plan by late summer, insurance companies will assume the subsidies are gone and set prices accordingly. That means higher premiums on the marketplace no matter what Congress decides to do later.

The Bottom Line

The government's enrollment number looks strong at first glance. But when you look closer, you see that most of the growth came from people paying nothing. If those people drop their coverage after the subsidies expire — and history says many will — the total number of insured people could fall sharply.

In the next few months, two things will signal what comes next. First, Congress will decide whether to extend the subsidies or pass a replacement plan. Second, insurance companies will file their prices for next year's plans with regulators. Those prices will show what insurers are assuming will happen when the current subsidies end.

Right now, the numbers show a successful program built on temporary government help. Most people who benefited from that help are the ones with the most to lose if it disappears.