Millions expected to lose Affordable Care Act coverage as costs spike
The economic crisis facing many people with health insurance under the Affordable Care Act became even clearer Tuesday; A new analysis predicts that higher premiums will cause millions more people to lose their insurance this year.
Another sign of economic distress: Average deductibles for policyholders have reached their highest level ever, as a result of people turning to the exchange’s cheapest “bronze plans” in response to premium increases, according to a report released Tuesday by health policy research firm KFF.
The KFF analysis found that with increased adoption of bronze plans, the average deductible for ACA recipients increased by more than $1,000 per year to $3,786.
There are two ways people lose coverage. First, premium increases prevented some from enrolling during last year’s open enrollment period. Millions of people who signed up can no longer afford the premiums and will lose coverage due to nonpayment.
The effects are a result of last year’s deadlock in Congress over covid-era ACA subsidies, which are set to expire starting this year. Republicans, who hold majorities in the House and Senate, have refused to extend the 2026 subsidies despite months of wrangling and a 43-day government shutdown.
While some experienced increases of up to 100 percent in their premiums, approximately 1 million people chose to opt out of 2026 coverage during last year’s open registration period. The KFF analysis says the loss from non-payment could increase by up to 4 million over the course of the year.
Overall, active registrations could fall from 22.3 million in 2025 to about 17.5 million in 2026, KFF said, citing a report by Wakely Consulting Group.
Enrollment declines were predicted by the Congressional Budget Office last year when bills to expand private subsidies were being debated. As the year 2026 began, the most dire predictions did not come true immediately. However, analysts say this effect will emerge as people stop paying premiums over time.
“Some people have dropped coverage altogether, some are paying higher premiums to maintain their plans, and some are moving to a basic, high-deductible plan,” said Cynthia Cox, KFF vice president and director of KFF’s program at ACA.
“The combination of all of these things is that people are experiencing huge cost increases,” he said.
People who are uninsured or have high deductibles take on more risks due to higher costs.
“On one side of the coin, people aren’t getting the care they need because they can’t afford it,” he said. “On the other side there are still people who need care they can’t avoid, who need emergency care or hospitalization, and who are going into medical debt.”
The state with the biggest decline in enrollment as of the beginning of the year was North Carolina, where it fell by nearly 214,000 people, or 22 percent, according to North Carolina Health News, which cited data from the Centers for Medicare and Medicaid Services.
“The storm is here and across this country. It’s going to get worse in the coming months as people can’t afford their premiums and drop insurance,” said Jonathan Oberlander, a professor of health policy at the University of North Carolina at Chapel Hill.
As costs rise and people across the country lose their insurance, Democrats are using ACA premium increases against House Republicans in some of the toughest midterm races spanning districts in New York, Pennsylvania, Michigan, Wisconsin, Iowa and California.
In Arizona, another state with a steep decline in ACA enrollment to start this year, the progressive group Our Protection took aim at Rep. David Schweikert (R), who is running for governor in the GOP primary, leaving open his seat representing Scottsdale and other parts of metro Phoenix. The district is rated poor by the Cook Political Report. Schweikert’s office did not respond to a request for comment.
The increase in the number of uninsured people will also increase due to mandatory eligibility verifications and work requirements for Medicaid, which are part of President Donald Trump’s Big Beautiful Bill, Oberlander said. Beyond the financial and health burden it creates for uninsured people, the “double whammy” of the ACA and Medicaid reductions will have a major impact on health systems, some of the largest employers in local communities, he said.
“Health care is a huge industry in North Carolina and beyond,” he said. “There are huge economic and political consequences.”
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