5 Million Lose ACA Coverage as Premiums Double; Medical Advances Offer Hope
The number of Americans enrolled in Affordable Care Act marketplace plans has plummeted by 5 million — the largest single contraction in the program’s history — after enhanced premium subsidies expired under the Trump administration. Meanwhile, two significant medical breakthroughs offer counterpoints of progress: a new blood test that detects 90% of aggressive prostate cancers and a long-awaited Lyme disease vaccine nearing regulatory review.
The ACA Enrollment Crisis
Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high of 24.2 million reached in 2025, according to data released Friday by the Department of Health and Human Services. Currently, 19.2 million people hold ACA coverage, NPR reported.
More than 1 million fewer people selected a plan for 2026 during open enrollment, and an additional 4 million either disenrolled or failed to pay their premiums, dropping coverage entirely.
The collapse followed the expiration of enhanced premium tax credits — subsidies enacted during the pandemic that capped insurance costs at 8.5% of income for all income levels. When Republicans in Congress declined to extend them, premiums doubled on average from 2025 to 2026. Democrats shut down the government in October 2025 in a failed attempt to negotiate an extension.
“The main takeaway is that enrollment is down 13% from last year,” said Cynthia Cox, director of KFF’s Program on the ACA. “While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments with the expiration of enhanced tax credits.”
The Trump administration and the conservative Paragon Health Institute have argued that the previous enrollment surge was driven by fraud. But most health policy experts are skeptical. Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms, told NPR: “I don’t see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud. There’s lots of evidence pointing to people making decisions based on what they can pay each month.”
The fallout extends beyond consumers. Several insurers, including Cigna, have announced they will not participate in ACA markets next year. Cox warned that if too many healthy people drop coverage, the markets could face a “death spiral” — though she said no regions are currently at risk of having zero insurers.
Early rate filings for 2027 indicate premiums will rise again next year, according to a Georgetown analysis, suggesting the enrollment decline may continue.
A Breakthrough in Prostate Cancer Detection
In medical news, researchers have demonstrated that a new blood test called Stockholm3 can detect 90% of aggressive prostate cancer cases, significantly outperforming the standard PSA test, which catches just 74%.
The study, published June 23 in the Annals of Internal Medicine, involved more than 12,000 men aged 50 to 74 from Sweden. All participants were tested with both PSA and Stockholm3 and followed for two years. During that period, 443 men were diagnosed with aggressive prostate cancer, Fox News reported.
Stockholm3 missed “significantly fewer” serious cancer cases than PSA, while the number of men incorrectly classified as high-risk was similar across both tests.
“Our results show that Stockholm3 identifies significantly more aggressive cancer cases than PSA, without increasing the number of unnecessary follow-ups,” said Thorgerdur Palsdottir, a researcher at Karolinska Institutet.
The PSA test has been the standard since the 1990s despite its “well-documented limitations,” according to Dr. Hari Vigneswaran, chief medical officer of A3P Biomedical, which developed Stockholm3. “It leads to invasive and costly follow-up testing, contributes to over-diagnosis of non-aggressive cancers and, most importantly, it misses a substantial share of aggressive disease.”
When aggressive prostate cancer is detected while still confined to the prostate, the five-year survival rate is close to 100%. Yet metastatic prostate cancer has risen over the past decade, suggesting current screening methods are failing to catch the disease early enough.
Stockholm3 is not yet available for sale in the U.S., but A3P Biomedical plans to seek FDA approval and generate American clinical data to support that pathway.
Lyme Disease Vaccine: Progress Amid Skepticism
Pfizer and Valneva announced this spring that they plan to seek regulatory approval for a Lyme disease vaccine candidate, which has shown about 75% efficacy in Phase 3 trials. The vaccine technically missed one statistical bar because not enough participants contracted Lyme disease during the study, but the companies maintain the results are strong enough to proceed, NPR reported.
About 476,000 people in the U.S. may be diagnosed with Lyme disease each year, according to the CDC, and the geographic range of cases has expanded significantly since 1995 due to climate change. A previous Lyme vaccine, LYMErix, was pulled from the market in 2002 after just three years due to lawsuits and public fear — concerns later found to be unfounded.
The path forward is complicated by the political landscape. HHS Secretary Robert F. Kennedy Jr., a former anti-vaccine activist, oversees vaccine approvals. He has remade the department in ways that have prompted some vaccine makers to pull back on development. Yet Kennedy has also been an advocate on Lyme disease, announcing an initiative to combat it in May.
KFF’s Ashley Kirzinger noted that if Kennedy endorses the vaccine, it could sway his supporters: “If he comes out as a strong proponent of this vaccine… I would imagine there would be less vaccine resistance among that group.”
Interviews with hunters — a group at high risk for Lyme but also associated with higher vaccine hesitancy — revealed a nuanced picture. Most said they would consider the vaccine but wanted more information about safety and effectiveness. “I would say I am vaccine-hesitant, generally speaking,” said Julian Barnes, a hunter. “But Lyme, I’ve seen the way it affects people in my life.”
Looking Ahead
The three stories paint contrasting pictures of American healthcare. The ACA enrollment collapse represents a significant setback for insurance access, with potential ripple effects for insurers and consumers alike. At the same time, advances in cancer screening and infectious disease prevention offer genuine hope — though their impact will depend on regulatory decisions, public acceptance, and political dynamics that remain deeply uncertain.