ACA Marketplace Enrollment Could Drop by 5 Million Due to Higher Costs

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Enrollment in the Affordable Care Act marketplace may ultimately fall by about 5 million people this year relative to 2025, as Americans face sharply higher costs triggered by a lapse in federal subsidies for healthcare premiums, according to a new study.

Marketplace enrollment could decline to roughly 17.5 million people in 2026 from 22.3 million people last year, a 21.5% drop, according to KFF, a nonpartisan health policy research group.

Its analysis, published Tuesday, is based on federal data and premium payment estimates from Wakely Consulting Group, a healthcare consultancy and actuarial shop.

The estimate comes as healthcare premiums for insurance plans bought on the Affordable Care Act marketplace — which is leveraged by the self-employed, gig workers, early retirees and others — have soared this year as Congress failed to extend so-called enhanced subsidies that reduced costs for most enrollees.

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An extension of those enhanced subsidies — also known as enhanced premium tax credits — was a key factor underpinning a record-long government shutdown in the fall.

Democrats pushed for an extension but were blocked amid Republican opposition. President Donald Trump and congressional Republicans have pushed for different policy ideas, such as sending direct payments to households for health expenses or depositing money in households' health savings accounts.

Meanwhile, households have cited health costs as a top financial concern, and policy experts say the topic could pose a threat to Republicans during a midterm election year in which affordability has emerged as a central theme.

Heading into 2026, KFF estimated that average ACA premiums would spike by 114% following the lapse of enhanced premium subsidies, which were first enacted in 2021 during the Biden administration. That figure assumed all enrollees stayed in the same health plan as in 2025.

Ultimately, premiums rose about 58%, to $178 per month from $113 per month, according to KFF.

The increase, while still high, was less than initially forecast because many households switched to health plans with lower premiums and higher deductibles, KFF said. Additionally, households facing the steepest premium increases were more likely than others to drop their insurance outright.

About 9.2 million people signed up for so-called bronze plans in 2026, up from 7.3 million in 2025, according to KFF. Such plans cost less up front but carry higher out-of-pocket costs on the back end if households need to use their insurance.

As a result, the average deductible for households across all ACA health plans swelled by 37%, to $3,786 in 2026 from $2,759 in 2025 — the "steepest increase in history," according to KFF.

About 23 million people signed up for ACA marketplace coverage during the open enrollment period for 2026 — a decline of about 1.5 million people from 2025 and the "sharpest single-year drop in raw numbers since the ACA Marketplaces launched," according to KFF.

A "significant number" of those enrollees are expected to lose their health coverage midyear in 2026 because they are financially unable to make premium payments to insurers, according to KFF. A more complete picture may not be available until later this year, when the federal government publishes more detailed data about enrollment, KFF said.