ACA Marketplace Enrollment Now Projected To Fall By About 5 Million In 2026
KFF released an analysis on Tuesday, May 19, 2026, projecting ACA marketplace enrollment will drop from about 22.3 million in 2025 to roughly 17.5 million in 2026.[1]
KFF found the average annual deductible rose by more than $1,000 and the average monthly premium payment increased by about $65 for 2026 plans, with many people shifting to lower-tier, higher-deductible options.[1] Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.[2]
On Jan. 1, 2026, enhanced COVID-era premium tax credits expired after a congressional deal to extend them collapsed, a change KFF links to the steep enrollment drop.[2] Many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026, and some are losing coverage mid-year when they can no longer afford monthly premiums.[1]
The Trump administration has said federal anti-fraud efforts explain much of the 2026 enrollment declines.[1] KFF's pricing-and-subsidy analysis challenges that account and notes insurers appear to have anticipated the enrollment and risk-shift effects, suggesting the 2026 changes may be a one-year shock.[2] KFF's projection represents a decline of more than 20 percent in marketplace enrollment from 2025 to 2026.[1]
Mainstream coverage frames the decline in ACA marketplace enrollment primarily as a consequence of rising costs and the expiration of enhanced premium tax credits. However, Politico argues that Democrats are strategically positioning this enrollment drop as a critical issue for the midterm elections, suggesting that they should leverage the narrative of rising premiums and deductibles to resonate with voters. This perspective emphasizes the political implications of the enrollment decline, which the mainstream summary does not address, particularly the potential for Democrats to use personal stories of those affected to highlight the real-world consequences of policy changes.
While the mainstream summary includes the Trump administration's claims regarding anti-fraud efforts as a factor in enrollment declines, it does not delve into the political dynamics surrounding these claims. Politico suggests that such Republican defenses are likely to be perceived as weaker in light of the tangible impacts of increased costs and loss of coverage. This contrast highlights a broader narrative about accountability and policy choices that the mainstream summary overlooks, particularly the call for Democrats to tie these issues directly to the administration's decisions and advocate for restoring subsidies as part of their campaign strategy.
Show source details & analysis (3 sources)
📌 Key Facts
- The KFF analysis, published on Tuesday, May 19, 2026 (Central), projects ACA marketplace enrollment will fall from about 22.3 million in 2025 to roughly 17.5 million in 2026 — a decline of nearly 5 million people (more than 20%).
- KFF attributes the sharp enrollment drop primarily to the Jan. 1, 2026 expiration of the enhanced premium tax credits after a congressional deal to extend them collapsed.
- Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.
- KFF finds remaining enrollees are paying more: the average annual deductible rose by more than $1,000 and the average monthly premium payment increased by about $65 for 2026 plans, with many shifting into lower‑tier, higher‑deductible options.
- Cox says insurers appear to have anticipated enrollment and risk‑shift effects reasonably well, suggesting the 2026 changes may be a one‑year shock rather than the start of repeated large price corrections, pending 2027 rate filings.
- Many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026, and some are losing coverage mid‑year when they can no longer afford monthly premiums.
- Middle‑income enrollees, who earn too much for remaining low‑income subsidies but not enough to comfortably absorb higher premiums, are disproportionately dropping coverage in 2026, KFF finds.
- States that run their own ACA exchanges are retaining a higher share of enrollees than states that rely on the federal marketplace.
- The Trump administration has publicly maintained that federal anti‑fraud efforts are responsible for much of the 2026 enrollment drop; KFF's pricing‑ and subsidy‑focused analysis implicitly challenges that characterization.
📊 Analysis & Commentary (1)
"The Politico Playbook piece argues Democrats should center the midterm campaign on the sharp 2026 ACA marketplace enrollment collapse (driven by expired enhanced tax credits), using concrete price and coverage harms as a pocketbook attack against Republicans while anticipating and outflanking GOP defenses such as 'anti‑fraud' explanations."
📰 Source Timeline (3)
Follow how coverage of this story developed over time
- The KFF analysis, published around Tuesday, May 19, 2026, projects nationwide ACA marketplace enrollment will fall from 22.3 million in 2025 to about 17.5 million in 2026, a decline of nearly 5 million people and more than 20%.
- KFF finds the average enrollee's annual deductible has increased by more than $1,000 and the average monthly premium payment has risen by $65 for 2026 plans.
- KFF attributes much of the enrollment drop and cost jump to the Jan. 1, 2026 expiration of enhanced COVID-era premium subsidies that had helped the vast majority of marketplace enrollees.
- The report notes that many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026; some are losing coverage mid-year when they can no longer afford their monthly premiums.
- KFF reports that middle-income enrollees, who earn too much for remaining low-income subsidies but not enough to comfortably absorb higher premiums, are disproportionately dropping coverage in 2026.
- The analysis finds states running their own ACA exchanges are retaining a higher share of enrollees than states that rely on the federal marketplace.
- The Trump administration has publicly maintained that federal anti-fraud efforts are responsible for most of the 2026 enrollment drop-offs, a characterization KFF's pricing- and subsidy-focused analysis implicitly challenges.
- On May 19, 2026, KFF released an analysis projecting ACA marketplace enrollment will fall from about 22 million in 2025 to roughly 17 million in 2026, a decline of about 5 million people.
- KFF links the sharp enrollment drop primarily to the expiration of enhanced premium tax credits at the end of 2025, after a congressional deal to extend them collapsed.
- Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.
- KFF finds that people who remained on ACA plans are paying more through higher premiums, higher deductibles, or both, and that many moved to lower-tier, higher-deductible plans.
- The report says deductibles for ACA marketplace plans rose by about $1,000 last year, the largest average increase KFF has recorded.
- Cox says insurers appear to have anticipated the enrollment and risk-shift effects relatively well, suggesting the 2026 changes may be a one-year shock rather than the start of repeated large price corrections, pending 2027 rate filings.