Affordable Care Act enrollment projected to plunge by 5 million as costs spike, analysis shows

May 20, 2026 - 03:47

A new analysis projects that enrollment in the Affordable Care Act marketplace will fall by roughly 5 million people, a decline of more than 20%, as rising costs push coverage out of reach for many Americans. The report highlights that those who stay enrolled are facing significantly higher out-of-pocket expenses, with average deductibles climbing by more than $1,000.

The study points to a combination of factors driving the exodus. Subsidies that expanded during the pandemic are set to expire, and insurers have raised premiums to cover rising medical costs. For lower-income households, the loss of enhanced tax credits means monthly payments could jump sharply, forcing some to drop coverage entirely. Meanwhile, middle-income earners who do not qualify for subsidies are also feeling the pinch, as plan prices outpace wage growth.

The projected drop would mark the largest single-year decline since the ACA's major expansion in 2014. Experts warn that the trend could worsen if Congress does not extend the enhanced subsidies, which are currently scheduled to end after 2025. Without action, the number of uninsured Americans is expected to rise, reversing years of gains under the law.

The analysis also found that even among those who keep their plans, the financial burden is growing. Deductibles have risen by an average of $1,000, meaning patients must pay more out of pocket before their insurance kicks in. For many, this makes coverage less useful for routine care, leading some to delay or skip medical visits.

The findings come as the Biden administration continues to push for making the enhanced subsidies permanent, but the proposal faces an uncertain future in a divided Congress.