The Affordable Care Act’s health insurance marketplace is on track to lose nearly 5 million enrollees this year, a 21% contraction that researchers attribute directly to the expiration of federal subsidies that had made coverage affordable for the vast majority of participants, according to a new analysis from the nonprofit healthcare research organization KFF. The projected decline, which far exceeds the drop suggested by early federal enrollment figures, stems from the Jan. 1 lapse of enhanced premium subsidies enacted during the coronavirus pandemic. Those subsidies had reduced out-of-pocket costs for roughly 9 in 10 marketplace enrollees.
MSI previously reported the KFF analysis’s headline findings earlier today. The report provides additional detail on the financial toll for those who remain insured.
The average enrollee’s deductible has risen by more than $1,000 and the average monthly premium payment has climbed by $65, KFF found. Deductibles are now at their highest levels since the marketplace launched in 2014.
“No matter how you slice it, people are paying more,” said Cynthia Cox, a KFF vice president who co-authored the report.
The enrollment decline is playing out mid-year, as Americans who signed up during the 2025 open enrollment period — when the subsidies were still in effect — are now reassessing whether they can afford to keep their plans. Unlike typical annual enrollment cycles, this is a continuous attrition driven by cost, researchers said.
The affordability crisis could shape the November midterm elections. Voter surveys in the most competitive House and Senate races have consistently ranked economic stress — including health care costs — as the top concern. The ACA’s fate, once a defining partisan wedge issue, has re-emerged as a practical pocketbook matter for millions of families.
KFF’s analysis arrives as Congress has not acted to restore the expired subsidies, despite bipartisan acknowledgments that premiums jumped sharply on Jan. 1. Senate negotiations early this year stalled over a dispute tied to abortion language, leaving the enhanced subsidies unrenewed.
The report projects that remaining enrollees will see continued cost increases. KFF researchers noted that the combination of a sicker, older risk pool — as healthier enrollees drop out — and the removal of subsidy-based premium suppression will drive further price growth in 2027 unless policy changes intervene.