Steep drop in number of people with Affordable Care Act health coverage, analysis finds

"As many as 5 million people who buy health insurance on the Affordable Care Act marketplaces may drop their coverage this year, according to a new analysis from KFF, the nonpartisan health research organization. That's many more than the initial enrollment statistics indicated. About one million fewer people signed up for a plan this year compared to the year before, but insurers, administrators, and other health policy experts warned that the picture would likely get worse as time went on and people found they could not afford to keep their plans."

"A major reason for the sharp drop in enrollment is that enhanced premium tax credits for these health plans expired at the end of last year. Congress came close to a compromise to extend the extra federal money that helped keep premiums down, but the deal fell apart. "Costs went up significantly and a lot of people dropped their plans," says Cynthia Cox, a co-author of the analysis and director of KFF's Program on the ACA."

"Although much of the information is still preliminary, the analysis projects that enrollment in these marketplaces will plunge this year, from 22 million in 2025 to about 17 million in 2026. This is similar to CMS's internal data as reported by NOTUS last week, the KFF analysis notes. The 5 million people dropping out of the markets could have bought health coverage elsewhere, but Cox says most probably became uninsured. "Those who stayed [in the marketplaces] are paying more, either in the form of higher premiums or higher deductibles or both," she says."

"Last fall, KFF projected that premiums were doubling on average. "What ended up happening is that a lot of people who had the steepest increases dropped coverage," she explains. "Also, a lot of people moved on to a lower level of""

Up to 5 million people buying health insurance through Affordable Care Act marketplaces may drop coverage this year. Enrollment is projected to fall from about 22 million in 2025 to roughly 17 million in 2026. The decline is linked to the expiration of enhanced premium tax credits that previously reduced premiums. Although Congress nearly extended the extra federal funding, the compromise failed. Costs rose significantly, leading many people to leave coverage, likely becoming uninsured. Those who remain in the marketplaces are paying more through higher premiums, higher deductibles, or both. The analysis uses data from federal and state marketplaces, KFF survey information, and estimates from Wakely Consulting Group, with some findings still preliminary.

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