Health care costs and insurance coverage have emerged as central issues in the 2026 midterm election cycle as millions of Americans face rising expenses. National data shows enrollment in the Affordable Care Act (ACA) marketplaces decreased by approximately 3 million people this year. This decline follows the expiration of enhanced federal tax credits last year, which has resulted in premium payment increases averaging 114 percent for many remaining enrollees.
The shifts in coverage come amid a broader debate over federal spending and program integrity. Vice President J.D. Vance announced this week that the administration plans to cancel insurance coverage for nearly 760,000 people currently enrolled through the ACA. Vance stated the move is intended to root out "widespread fraud," asserting that most of the targeted individuals may be fraudulently enrolled. The administration plans to conduct additional verification for approximately 419,000 of these individuals to confirm their legal residency and income eligibility for benefits.
Larry Levitt, executive vice president for health policy at KFF, noted that while some fraud is perpetrated by rogue insurance brokers who mislead applicants, the expiration of federal credits is a primary driver of coverage loss. Levitt explained that those dropped from coverage for lacking documentation, such as Social Security numbers or proof of immigration status, generally have a 30-day window to confirm their details after notification. He stated that an appeals process exists to allow those who are legitimately eligible to regain their health insurance.
The financial pressure extends beyond premiums, as Americans currently hold over $200 billion in medical debt. According to Levitt, hospital prices are a primary driver of these rising costs, accounting for 40 percent of recent increases as facilities merge and grow larger. A KFF poll conducted this summer indicated the breadth of this concern, with 51 percent of voters stating it is extremely important for candidates to address health care. Among Republican voters specifically, 55 percent cited fraud in government programs like Medicaid and Medicare as an extremely important issue to address.
These developments set the stage for competing policy approaches as the midterm elections approach. Democrats have proposed measures ranging from "Medicare for All" to incremental steps such as restoring $900 billion in Medicaid cuts previously passed by Republicans and capping hospital prices. The outcome of the elections will determine the viability of these proposals, though divided government would likely limit the implementation of any single party's full health care agenda. Further verification checks for the 419,000 individuals identified by the Vice President are expected to proceed as the administration seeks to finalize the cancellations.