ACA Marketplace Enrollment Projected to Fall by Nearly 5 Million in 2026

Enrollment in the Affordable Care Act’s health insurance marketplaces is projected to drop sharply this year, with millions of Americans expected to lose coverage as they grapple with significantly higher costs following the expiration of federal subsidies. A new analysis from the health policy nonprofit KFF estimates enrollment could fall by nearly 5 million people, from 22.3 million in 2025 to about 17.5 million in 2026, a decline of more than 20 percent.

The projected drop is attributed primarily to the Jan. 1 expiration of enhanced premium tax credits that were first expanded in 2021. Those subsidies had helped a broad range of enrollees, particularly middle-income individuals, afford their monthly premiums. With those supports gone, average monthly premium payments after subsidies rose by 58 percent, from $113 to $178, according to the analysis. At the same time, the average annual deductible for marketplace plans increased by 37 percent, or more than $1,000, reaching a record $3,786.

Cynthia Cox, a KFF vice president who co-authored the report, stated that people are paying more no matter how you look at it. She noted that many enrollees were auto-renewed into plans from...