Higher health insurance costs are forcing some people to walk away from coverage even after signing up.
About 14% of people who enrolled in Affordable Care Act (ACA) plans for 2026 did not pay their first monthly premium, according to a new analysis from Wakely Consulting Group, an actuarial firm.
That’s much higher than the usual early-year drop-off, which is typically in the mid-single digits.
“It’s a big drop,” Michelle Anderson, a consulting actuary at Wakely, told The Wall Street Journal.
It likely owes to premium hikes following expiration of expanded federal subsidies introduced during the pandemic.
Enrollment was already slipping, falling to 23 million in 2026 from more than 24 million last year. Millions more could lose coverage if they don’t make payments within a three-month grace period, The Wall Street Journal reported.
Some patients say the cost increases left them with limited options.
Sarah Smith, a 53-year-old office manager in Ohio, said her monthly premium jumped from about $150 last year to roughly $700 after losing her subsidy. Her ACA policy also covered her 20-year-old son.
She decided to buy a cheaper short-term policy instead, even though it offers less protection.
“I try not to think about it,” Smith told The Wall Street Journal. “Knock on wood, hope that he’s OK, I’m OK,” she said, referring to herself and her now uninsured son.
Others are going without insurance entirely. Sharon Dunham, a 63-year-old cancer survivor, said her monthly premium would have risen to about $980, up from $614 last year.
“It is definitely terrifying,” she told The Wall Street Journal. “There’s the very real possibility that I can’t do anything if it shows up.”
Experts say rising costs can change who stays insured. Younger, more healthier people are more likely to drop coverage.
Wakely’s data showed that people who paid their initial premiums in 2026 were about 10% less healthy, based on their expected medical costs, than those who did not pay at all.
That shift could lead to higher premiums in the future, as insurers raise prices to cover increased costs.
The impact varies by state. Some states saw higher rates of people not paying, especially those using HealthCare.gov.
In Arizona, Blue Cross Blue Shield reported losing more than 30% of its ACA enrollees for 2026 due to non payments, compared with 2% last year.
“It is simply because the cost of health insurance is more than what they can afford,” CEO Pam Kehaly said.
Wakely estimates that ACA enrollment could drop by 17% to 26% this year compared to 2025.