Enrollment in the Affordable Care Act marketplace is projected to fall by nearly 5 million people this year as rising premiums and higher deductibles force many Americans to reconsider whether they can still afford health insurance coverage, according to a new analysis from healthcare nonprofit KFF.
The report estimates ACA enrollment could decline from 22.3 million participants in 2025 to roughly 17.5 million this year, representing a drop of more than 20 percent.
At the same time, Americans who remain enrolled are paying substantially more out of pocket. According to the analysis, average deductibles have climbed by more than $1,000, while monthly premium payments have increased by an average of $65.
“No matter how you slice it, people are paying more,” said Cynthia Cox, who co-authored the report.
The sharp enrollment decline comes after the expiration of enhanced COVID-era subsidies that had artificially lowered costs for many Obamacare enrollees over the past several years. Without those subsidies, many middle-income Americans are now struggling to keep up with rising monthly payments.
KFF found that middle-income Americans were among the most likely to drop their coverage. Many earn too much to qualify for the remaining low-income subsidies but not enough to comfortably absorb the higher costs now hitting the marketplace.
The ACA marketplace, once promoted as a cornerstone of Democrat healthcare policy, has become increasingly important for gig workers, farmers, ranchers, hairstylists, and self-employed Americans who do not receive employer-sponsored coverage.
According to the report, many consumers were automatically renewed into plans from the previous year, only to discover that costs had risen dramatically after the subsidies expired. In many cases, Americans initially kept their coverage before dropping it later in the year once the monthly bills became unaffordable.
“People are trying to hang on to their health insurance coverage any way they can, even if that means they have a deductible of $7,000,” Cox said.
The report found that enrollment declines occurred across most states, although states operating their own healthcare exchanges generally retained more participants than states relying on the federal marketplace.
The Trump administration has argued that some of the enrollment decline stems from efforts to remove fraud and improper enrollments from the ACA system. Federal officials have not yet released final 2026 enrollment figures.
KFF had previously projected that premiums could more than double after the COVID-era subsidies ended. The new analysis found that premiums instead rose by an average of 58 percent, partly because many Americans switched into cheaper plans with significantly higher deductibles and reduced coverage.
The rising costs and shrinking enrollment are expected to become a major issue heading into the midterm elections as voters increasingly focus on inflation, affordability, and broader economic pressures.
Cox suggested insurers may now be adjusting to the post-subsidy market environment, potentially reducing the likelihood of another major premium spike next year.
“I’m hopeful that this could be a one-time market correction,” she said.