Millions of Americans are dropping their Affordable Care Act (ACA) marketplace health insurance plans due to the expiration of enhanced federal subsidies at the end of 2025. This has resulted in a substantial increase in premiums, with some individuals seeing their monthly costs spike hundreds of dollars. For example, a 26-year-old Brooklyn bookstore manager experienced a jump from $147 to $849 per month for her premium. This "sticker shock" has caused a significant number of enrollees to not pay their first month's premium, a sharp increase from typical rates.
According to an analysis by Wakely Consulting Group, approximately 14% of ACA enrollees nationwide failed to pay their first month's premium for 2026 plans, a notable jump from the usual mid-single-digit drop-off. In some states, this non-payment rate reached 25% or more. This non-payment trend, coupled with widespread cancellations, has led Wakely actuaries to project an overall ACA enrollment fall of between 17% and 26% compared to the previous year. Blue Cross Blue Shield of Arizona reported losing over 30% of its initial 2026 enrollees, almost entirely due to nonpayment.
The lapse of the enhanced subsidies, which were introduced during the pandemic under the American Rescue Plan Act, coincided with significant rate hikes from insurers due to rising medical costs. These subsidies had made insurance free for the lowest-income customers and provided new assistance to those earning up to approximately $63,000 annually. Without this financial help, many consumers are finding comprehensive coverage unaffordable, with some opting for short-term plans or going uninsured. KFF estimates that ACA enrollment could decline to roughly 17.5 million people in 2026 from 22.3 million in 2025, a 21.5% drop.
The impact on the ACA risk pool is also a concern for actuaries and insurers, as healthier, often younger, individuals are more likely to drop coverage. This leaves a sicker and more expensive membership, which could drive future premiums even higher. A recent KFF survey cited by PBS indicated that about 55% of ACA enrollees planned to cut back on essential expenses like food to afford their healthcare costs. The average deductible for ACA plans also swelled by 37%, from $2,759 in 2025 to $3,786 in 2026, marking the steepest increase in history.
