Drop in ACA Enrollment and Rising Health Insurance Costs: A KFF Analysis
Nationwide enrollment in the Affordable Care Act (ACA) health insurance marketplace is poised for a significant decrease, with projections indicating a drop by nearly 5 million participants this year. This potential reduction, exceeding 20%, is based on a recent analysis by KFF, a leading healthcare research organization. The report also highlights a rise in healthcare costs for those maintaining coverage, with average deductibles increasing by over $1,000 and monthly premiums climbing by $65.
Cynthia Cox, a KFF vice president and co-author of the report, emphasized that individuals are encountering higher expenses. The analysis suggests that this enrollment decline surpasses previous federal estimates, driven by escalating health costs. A key factor is the expiration of subsidies that had provided critical support to many enrollees, forcing them to reassess their insurance options mid-year.
According to KFF’s report, ACA enrollment is expected to drop from 22.3 million participants in 2025 to about 17.5 million this year. The analysis utilizes data from both federal and state sources, as well as insights from the actuarial firm Wakely Consulting Group. This points to a notable reduction for the primary subsidized health insurance program serving working-age Americans who don't qualify for Medicaid.
The decline is largely due to automatic renewals into costlier plans as a result of expired subsidies. Many individuals find themselves unable to afford these monthly premiums, leading to loss of coverage. The report indicates a high incidence of coverage loss among middle-income Americans, who neither qualify for existing low-income subsidies nor can they shoulder the insurance costs without the earlier COVID-era subsidies.
KFF's findings show enrollment reductions in most states, with those operating their own exchanges faring better in retaining enrollees compared to states using the federal marketplace. The Trump administration has suggested that federal initiatives to combat fraud within the ACA program have contributed to the current decline in sign-ups. However, the Centers for Medicare and Medicaid Services have yet to comment on KFF’s analysis, as the official 2026 enrollment numbers remain undisclosed.
Looking ahead, KFF initially anticipated premium payments to more than double by 2026 following the end of COVID-era subsidies. However, the report now forecasts a more moderate increase of 58% on average. This is largely because many enrollees have switched to plans with lower premiums but higher deductibles, facing greater costs only upon accessing services.
Cox noted that while some individuals are trying to maintain coverage by opting for plans with substantial deductibles, insurers may have already adjusted for many marketplace changes. This could potentially stabilize premium increases in the future, providing a glimmer of hope for enrollees amidst regulatory challenges.