Impact of ACA Enrollment Decline on Health Insurance Premiums and Rates

A recent analysis by KFF, a healthcare policy research organization, indicates that Affordable Care Act (ACA) enrollment might decrease by approximately 5 million people this year. This potential drop is linked to the absence of extended enhanced subsidies by Congress beyond 2025. During the open enrollment period for 2026, initial sign-ups for ACA plans saw a reduction by over 1 million, with total enrollment reaching 23.1 million, according to KFF. However, premium payment trends suggest this figure might decline further.

Premium payments have risen significantly, with an average increase of 58%, moving from $113 to $178 per month. Consequently, the number of paid enrollments, known as "effectuated" enrollments, could decrease to around 17.5 million, and possibly as low as 16.5 million, compared to the 22.3 million reported last year. Additionally, out-of-pocket expenses are on the rise, with the average ACA deductible increasing by 37%, marking a new peak for marketplace plans. This change raises the deductible from $2,759 in 2025 to $3,387 in 2026.

The possibility of reduced enrollment next year might lead insurers to consider rate hikes for 2027. This is particularly likely if younger, healthier individuals opt out of coverage, potentially skewing the insured pool toward an older and less healthy demographic. Michelle Anderson, a director at Wakely Consulting Group who has researched early 2026 enrollment patterns, indicated that while the 2027 premium rate hikes may not be as steep as those for 2026, insurers might still implement some increases. She stated, "It would not surprise me if there were some double-digit increases," although the industry is not yet raising significant concerns.