Decreasing ACA Enrollment: A 20% Drop and Rising Premiums
Nationwide participation in the Affordable Care Act (ACA) marketplace might decrease by nearly 5 million individuals this year, reducing the program's enrollment by over 20%, according to a recent analysis from the healthcare research organization KFF. The study indicates that those continuing with the ACA are encountering higher healthcare costs, with average deductibles increasing by over $1,000 and monthly premiums rising by $65.
Cynthia Cox, a vice president at KFF and co-author of the report, states, "No matter how you slice it, people are paying more." The projected downturn, which is more severe than earlier federal projections, illustrates how increased health costs—partly due to the expiration of subsidies on January 1—are compelling people to reevaluate their health coverage decisions mid-year.
According to the KFF report, derived from both federal and state data as well as insights from Wakely Consulting Group, ACA enrollment could dip from 22.3 million in 2025 to about 17.5 million this year. The ACA serves as a crucial insurance option for working-age Americans outside Medicaid, particularly appealing to gig workers, farmers, and others without employer-provided health coverage.
Impact of Automatic Renewals and Market Dynamics
The decline is partly attributed to automatic renewals, which have led to costlier plans due to subsidy expirations and market changes, Cox explained. Many become unable to sustain monthly premiums, resulting in coverage loss. The report also shows that middle-income participants dropped out more frequently than other groups because they no longer qualify for the remaining subsidies for low-income enrollees. Conversely, states with their own exchanges managed to retain more enrollees compared to those relying on the federal marketplace.
Although the Trump administration has attributed some of the drop-off to anti-fraud measures within the ACA program, the Centers for Medicare and Medicaid Services have not yet commented on KFF's findings, as their final 2026 enrollment data remains unpublished.
Future Outlook on Premiums and Market Adjustments
Regarding costs, KFF previously anticipated that expiring COVID-era subsidies could double premium payments by 2026. However, premiums increased by 58% on average, as many people switched to plans with lower premiums but higher deductibles. Cox noted that individuals are striving to keep their insurance, even if it means significantly higher deductibles.
Caitlin McElroy from Orlando, Florida, whose premium increased from $32 to $89 per month, is one example of those making sacrifices to afford necessary coverage. As she manages her Crohn's disease and mental health, McElroy prioritizes insurance over other expenditures.
Cox expressed optimism, suggesting that insurers possibly anticipated the marketplace changes and adjusted accordingly, which may prevent excessive premium increases in the future. 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."