ACA enrollment may drop 5 million

KFF said on May 19 that Affordable Care Act marketplace enrollment could fall to about 17.5 million in 2026, down from 22.3 million in 2025, if the enhanced federal premium tax credits that expired are not restored. The estimate amounts to roughly 5 million fewer enrollees, or a 21.5% decline, according to the health policy group. CNBC, citing the KFF analysis, reported that higher out-of-pocket premium costs are expected to push many households off coverage. ### How big is the projected drop? KFF estimated enrollment could fall from 22.3 million in 2025 to about 17.5 million in 2026. The group tied that projection to the expiration of the enhanced premium tax credits that had lowered monthly costs for many marketplace customers. CNBC reported on May 19 that the projected decline would leave marketplace sign-ups about 5 million below last year’s level. (cnbc.com) KFF’s May 19 release also said average marketplace deductibles rose by 37%, or more than $1,000 per person, to $3,786 in 2026 from $2,759 in 2025. ### Why are costs rising now? KFF said the enhanced premium tax credits expired, raising what many enrollees have to pay to keep coverage. (cnbc.com) In an earlier KFF brief, the group estimated premium payments for subsidized enrollees who stayed in the same plan increased 114% on average after the enhanced credits ended. KFF said the higher deductibles in 2026 also reflect a shift by enrollees from silver plans with lower deductibles into bronze plans with higher deductibles. The organization described the 2026 deductible increase as the steepest in marketplace history. (kff.org) ### Who is most exposed to the subsidy change? KFF said the burden is uneven, with people above 400% of the federal poverty level facing some of the largest premium increases because they no longer qualify for the same level of help. In a separate mapping analysis, KFF said many enrollees in that income range are ages 50 to 64, a group that tends to face higher unsubsidized premiums. (kff.org) CNBC reported that about 22 million people received enhanced premium tax credits last year, covering more than 90% of ACA marketplace enrollees. That scale helps explain why the subsidy change can move enrollment totals by millions rather than thousands. ### Is the decline already showing up in 2026 data? KFF said plan sign-ups during the 2026 open enrollment period fell by more than 1 million to 23.1 million, which it called the sharpest single-year drop since the ACA marketplaces launched. (kff.org) The group also said the early data do not yet capture the full effect because some people who selected plans may later fail to pay and lose coverage. (cnbc.com) CNBC reported in February that at least 1.5 million people had already dropped out of the ACA marketplace, based on early Centers for Medicare & Medicaid Services data reviewed by KFF. KFF has also said it is not yet clear how many people who selected a plan during open enrollment will ultimately make a payment and stay enrolled. (kff.org) ### What are enrollees saying about the impact? KFF said in a March follow-up survey that 51% of returning marketplace enrollees said their health care costs were “a lot higher” in 2026 than a year earlier. The same survey found one in 10 had dropped marketplace coverage and were uninsured, while three in 10 switched ACA plans, most citing high costs. (cnbc.com) KFF’s May 19 analysis and related releases are now the main public benchmark for how much enrollment, premiums and deductibles changed after the subsidy expiration. Further enrollment updates will depend on additional marketplace and federal data showing how many 2026 plan selections turn into paid, active coverage. (kff.org 1) (kff.org 2)