Decline in ACA Enrollment Due to Expired Subsidies

Nationwide participation in the health insurance marketplace under the Affordable Care Act (ACA) is expected to decrease significantly this year, a trend highlighted by a study from KFF, a healthcare research nonprofit. The study forecasts a drop of nearly 5 million enrollees, a decrease of over 20% from current numbers. This decline is attributed to the expiration of subsidies that previously helped individuals afford their coverage.

KFF's findings suggest that individuals who remain covered face increased healthcare costs. The average deductible for enrollees has risen by more than $1,000, while the average monthly premium payment is up by $65. Cynthia Cox, a vice president at KFF and a co-author of the report, observed, "No matter how you slice it, people are paying more."

The report, which draws on federal and state data and Wakely Consulting Group analyses, predicts that ACA enrollment could fall from 22.3 million in 2025 to approximately 17.5 million this year. This substantial reduction impacts a vital resource for working-age individuals without employer-provided health insurance, including gig workers and tradespeople.

A key factor behind the enrollment drop is the costly auto-renewal of plans without subsidies. Cox noted that many people face challenges keeping their coverage amid rising costs. The report also highlights that middle-income Americans disproportionately drop coverage, as they earn too much to qualify for remaining low-income subsidies yet not enough to manage health insurance expenses alone.

Despite widespread enrollment declines, states with state-run exchanges have retained more enrollees compared to those relying on the federal marketplace. The Centers for Medicare and Medicaid Services have yet to comment on the KFF report, and final enrollment figures for 2026 are still pending.

Looking ahead, Cox suggested insurers might have anticipated these marketplace dynamics and adjusted. This foresight could prevent sharp premium spikes in the future, as she stated, "I'm hopeful that this could be a one-time market correction and that we might not need to see such a high premium spike in the coming year."