ACA enrollment at risk: 5 million could lose coverage this year, analysis says

X Facebook WhatsApp

A new analysis from the nonpartisan Kaiser Family Foundation warns that sharply higher premiums after federal subsidy protections lapsed could push roughly 5 million people off the Affordable Care Act marketplaces in 2026. The shift in costs is already reshaping choices for millions of Americans who buy insurance on the exchanges and has immediate political and financial implications.

KFF’s projection and how it was calculated

KFF estimates marketplace enrollment will fall to about 17.5 million in 2026 from 22.3 million in 2025 — a decline of roughly 21.5%. The projection, published Tuesday, relies on federal enrollment data and premium-payment modeling from Wakely Consulting Group.

The change traces to the expiration of enhanced premium tax credits, first expanded in 2021. Those subsidies had substantially lowered monthly premiums for many enrollees; once they lapsed, out-of-pocket costs increased sharply for people who shop on the exchanges.

Premiums, plan choices and deductibles

KFF initially modeled a scenario in which premiums would more than double — a 114% jump — if everyone remained in the same plan. In practice, average monthly premiums rose about 58%, from $113 to $178, because many consumers shifted to cheaper plans or dropped coverage.

That shift favored lower-premium, higher-deductible options. Enrollment in so-called bronze plans climbed to 9.2 million in 2026 from 7.3 million the year before. Across all ACA plans, the average deductible rose by 37% to $3,786 — what KFF called the steepest increase on record.

Projected enrollment (2026): 17.5 million

Enrollment (2025): 22.3 million

Open enrollment sign-ups (2026): ~23 million (down ~1.5 million from 2025)

Average monthly premium (2026): $178 (up from $113)

Average deductible (2026): $3,786 (up from $2,759)

Bronze plan enrollees (2026): 9.2 million (up from 7.3 million)

What to expect over the year

Although 23 million people signed up during the open enrollment window for 2026, KFF warns a “significant number” are likely to lose coverage midyear if they cannot keep up with premium payments. The group says a fuller enrollment picture will emerge when the federal government releases more detailed data later this year.

For consumers, the practical result is clearer: many will face lower monthly premiums but higher financial risk when they need care, or no coverage at all if they skip payments. For the self-employed, gig workers and early retirees who rely on the exchanges, those trade-offs will often be acute.

Political context and implications

The lapse of enhanced subsidies was a central item in fall budget fights. Democrats sought to extend the credits; Republicans blocked that effort. Republican leaders, including President Donald Trump, have proposed alternative approaches, such as one-time payments for health costs or increased contributions to health savings accounts.

Health care affordability is a top concern for many households, and analysts say rising premiums and deductibles could influence voter sentiment in midterm contests where cost-of-living issues are already prominent.

Policy choices in the coming months — whether lawmakers restore subsidies, adopt alternative assistance, or leave the system unchanged — will determine whether the marketplace stabilizes or whether enrollment and coverage losses accelerate.