Pandemic-era subsidies tied to the Affordable Care Act have expired, and the effects are beginning to spread across the U.S. insurance market. According to a new analysis from KFF, millions of Americans may lose health coverage this year as rising premiums and deductibles place increasing pressure on household budgets.
The report points to growing affordability problems among ACA policyholders, many of whom are either dropping coverage entirely or switching to lower-cost plans with higher out-of-pocket expenses. Analysts say the changes stem largely from Congress’s decision not to extend enhanced subsidies that had been introduced during the pandemic.
For many consumers, the impact became visible during the most recent enrollment cycle. Premium increases discouraged some people from signing up in the first place, while others who enrolled are now struggling to keep up with monthly payments. According to KFF, these trends are expected to continue throughout 2026 as more policyholders fail to pay premiums and lose coverage.
The issue has also become politically charged ahead of the midterm elections, particularly in battleground districts where ACA enrollment declines have been steep.
Higher Costs Push Consumers Toward Reduced Coverage
According to KFF, average deductibles for ACA recipients have climbed to their highest level on record as more consumers move into lower-premium “bronze plans.” The organization found that the average deductible increased by more than $1,000 annually, reaching $3,786.
Cynthia Cox, vice president at KFF and director of its ACA program, said consumers are responding to premium hikes in different ways. Some are abandoning coverage altogether, while others are paying more to maintain their existing plans or switching to plans with fewer benefits and higher deductibles. “The combination of all that is people are experiencing big cost increases,” Cox said.
The report also noted that premium increases reached as high as 100 percent for some consumers after enhanced ACA subsidies expired at the start of 2026. Republicans in Congress declined to renew the subsidies despite months of negotiations and a 43-day government shutdown tied partly to the debate.
According to KFF, around 1 million people opted out of ACA coverage during the last open enrollment period because of the rising costs. Another 4 million people could lose coverage later this year due to nonpayment of premiums. The organization, citing data from Wakely Consulting Group, estimated that active ACA enrollment may decline from 22.3 million in 2025 to approximately 17.5 million in 2026.
Enrollment Declines Deepen Concerns Over Uninsured Rates
Analysts say the full effect of the subsidy expiration may take time to emerge because many consumers initially remained enrolled before falling behind on payments. According to the Congressional Budget Office, declines in enrollment had already been anticipated during last year’s legislative debate over extending the subsidies.
North Carolina has experienced one of the largest enrollment drops so far. North Carolina Health News, citing Centers for Medicare and Medicaid Services data, reported that ACA enrollment in the state fell by roughly 214,000 people, or 22 percent, at the beginning of the year.
Jonathan Oberlander, a health policy professor at the University of North Carolina at Chapel Hill, said the situation is likely to worsen as affordability pressures continue. “The storm is here, and that’s true across the country,” Oberlander said. “It’s only going to intensify in the coming months as people can’t afford their premiums and they drop coverage.”
Oberlander also warned that additional Medicaid eligibility checks and work requirements included in President Donald Trump’s One Big Beautiful Bill could increase the number of uninsured Americans further. He said the combined effects on ACA and Medicaid coverage may also place financial strain on hospitals and health systems, which remain major employers in many local communities.
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