An Obamacare sign hangs outside an insurance agency in Miami on November 12, 2025.
Joe Radle | Getty Images News | Getty Images
The number of people enrolled in the Affordable Care Act market could ultimately decline by about 5 million people compared to 2025, according to a new study, as Americans face steep cost burdens due to the expiration of federal health insurance premium subsidies.
Marketplace enrollment could drop 21.5% from 22.3 million last year to about 17.5 million in 2026, according to KFF, a nonpartisan health policy research group.
The analysis, released Tuesday, is based on federal data and premium payment estimates from Whaley Consulting Group, an actuarial practice for health care consulting firms.
The estimates come as health insurance premiums for insurance plans bought on the Affordable Care Act marketplace for self-employed people, gig workers, early retirees and others have soared this year after Congress failed to extend so-called subsidy expansions that would reduce costs for most enrollees.
KFF estimated that for 2026, average ACA premiums will jump 114% after enhanced premium subsidies first enacted in 2021 under the Biden administration expire. This figure assumes that all members still have the same health insurance in 2025.
Ultimately, premiums rose about 58%, from $113 per month to $178 per month, according to KFF.
KFF said the increase, while still high, was lower than originally predicted as more households switched to health insurance with lower premiums and higher deductibles. Additionally, households facing sharp increases in premiums were more likely than other households to drop their insurance altogether.
About 9.2 million people will enroll in so-called bronze plans in 2026, up from 7.3 million in 2025, according to KFF. Such plans have lower initial costs, but higher out-of-pocket costs on the back end when households need to use insurance.
As a result, the average household deductible across all ACA health plans increased by 37%, from $2,759 in 2025 to $3,786 in 2026. According to KFF, it was the “fastest increase in history.”
According to KFF, approximately 23 million people enrolled in the ACA Marketplace during the 2026 open enrollment period. This is a decrease of approximately 1.5 million people from 2025, making it “the steepest decline in the number of births in a single year since the launch of the ACA Marketplace.”
According to KFF, a “significant number” of these members are expected to lose their health insurance by mid-2026 because they are financially unable to pay premiums to their insurance companies. A more complete picture may not be available until later this year, when the federal government releases more detailed data on enrollment, KFF said.
