Millions of Americans expected to lose health insurance as ACA premiums rise
Fewer and fewer people are signing up for insurance under the Affordable Care Act (ACA) as premium prices rise, and a new analysis shows millions more are likely to lose their coverage this year.
After seeing record enrollment in 2025, ACA enrollment was down by about 1.2 million in January compared to last year, according to a report released Tuesday by KFF. And those who have enrolled this year face premium rates that have increased up to 100%, while subsidies that help pay for them have all but vanished.
By the numbers
From 2025 to 2026, overall premiums rose by an average of 26%, leaving more people opting for the “bronze plan,” which features lower premiums but higher deductibles. KFF found that sign-ups for bronze plans jumped to 40% of total plan selections, with 9.2 million people opting for that plan this year compared to 7.3 million in 2025.
A deductible is the amount of money people must pay out-of-pocket before insurers pitch in. This year, the bronze plan’s average deductible is up 37% – or more than $1,000 – to $3,786.
And despite more people opting for the lower-premium plans, millions still struggle to keep up with the monthly cost of insurance.
Unbiased. Straight Facts.TM
Average ACA enrollment is expected to end up being 17% to 26% lower in 2026 than 2025, according to an estimate by Wakely Consulting Group.
More than a million people insured under the ACA, also known as Obamacare, have already lost coverage for 2026 after being forced to opt out because they could not afford the monthly premium for even the cheapest plan. Experts expect that to rise to about 4 million by the end of the year as those who still have coverage struggle to make their monthly payments.
In a recent report, the digital news website NOTUS said it had obtained internal data from the Centers for Medicare & Medicaid Services, showing that roughly 21% of people who got insurance through the federal ACA marketplace failed to pay their January premium. Thirty states rely on the federal marketplace for Obamacare enrollment.
Experts say the millions of people losing coverage are facing a no-win situation, both medically and financially. The ACA works in a similar fashion to a private employer’s healthcare plan. If a large portion of healthy enrollees who act as a cost offset leave the plan, those who remain must pay more to afford care.
“On one side of the coin, people are not getting the care they need because they cannot afford it,” Cynthia Cox, a KFF vice president and the director of KFF’s program on the ACA, told The Washington Post. “On the other side are people still needing care they cannot avoid, emergency care or a hospitalization, where they go into medical debt.”
States that run their own ACA marketplaces saw fewer people unable to pay their premiums, with an average of 92% maintaining coverage. States with the lowest drop-off rates often used state money to make up for part or all of the reduced subsidy amounts as a result of recent changes by the Trump administration, according to a report from Wakely Consulting Group.
The role of Trump’s ‘Big, Beautiful Bill’
It’s not just premium costs that are keeping millions of Americans from getting the health coverage they need.
Mandatory eligibility verifications and work requirements for Medicaid that were part of President Donald Trump’s One Big Beautiful Bill (OBBB) Act will also cause more people to forgo insurance, Jonathan Oberlander, a professor of health policy at the University of North Carolina at Chapel Hill, told the Post.
Despite Democrats’ push to extend Obama-era healthcare subsidies, the OBBB defunded them.
Here’s how ACA subsidies work: most tax credits are provided as advance premium tax credits, meaning that an enrollee predicts their income at the beginning of the year, and assistance is based on that estimate, according to the American Medical Association (AMA). If the enrollee ends up making more money than they predicted, they have to repay some of the money.
Prior to the passing of the OBBB, caps on repayment requirements protected low-income enrollees. Those protections have now been eliminated, meaning many people could have significant financial liabilities as a result, Emily Carroll, a senior attorney with the AMA Advocacy Resource Center, said.
The OBBB also all but terminated a special enrollment program that allowed low-income people to enroll in Obamacare year-round. As of this year, people who enroll in ACA Marketplace coverage during a special enrollment period that’s based on the individual’s income, rather than a qualifying life event, will not be eligible for premium tax credits.
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Ella Rae Greene, Editor In Chief
