Impact of Rising ACA Premiums on Enrollment and Coverage

Insurance brokers are currently grappling with increasing pressures from rising premiums and deductibles in the Affordable Care Act (ACA) market. A recent analysis by KFF, a prominent health policy organization, highlights that these financial increases could lead to a significant decline in the number of insured individuals, with millions potentially losing coverage this year.

The shift towards "bronze plans," popular for their lower premiums, has inadvertently caused higher deductibles for many policyholders. According to KFF's findings, the average deductible for ACA enrollees has risen by over $1,000, bringing it to $3,786. This trend is driven by premium hikes that are proving difficult for many to manage, straining financial resources.

Coverage losses continue as some individuals struggle with affordability issues. Last year, many forwent enrollment due to high costs, and those who did enroll now find premium payments unsustainable. The recently expired pandemic-era ACA subsidies, which were not extended due to a Congressional impasse, have exacerbated these affordability challenges amid political negotiations and the government shutdown.

Significant premium increases, in some cases reaching 100%, led about one million people to skip coverage during the 2026 open enrollment period. KFF projects that up to 4 million more could lose insurance this year for non-payment, potentially reducing overall enrollment from 22.3 million in 2025 to 17.5 million in 2026, as anticipated by Wakely Consulting Group.

Cynthia Cox, a vice president at KFF, stresses the increasing financial burden on individuals, many of whom are opting for lower-tier, higher-deductible plans. This is causing a dual problem where individuals must either delay essential medical care due to prohibitive costs or accrue medical debt from emergency situations.

North Carolina, in particular, has witnessed a significant drop in enrollment, with approximately 214,000 fewer enrollees, marking a 22% decrease at the start of the year, based on Centers for Medicare and Medicaid Services data. Jonathan Oberlander, a health policy professor, warns that this trend is likely to worsen as affordability issues persist.

The repercussions of reduced public insurance options and rising uninsured rates are substantial, presenting major challenges for health systems, which are key employers in many regions. The collective impact of ACA and Medicaid reductions is expected to strain these systems and affect local economies. Consequently, policymakers and stakeholders are keenly observing these trends as debates over potential regulatory changes continue.