The affordability crisis for many people who have health insurance under the Affordable Care Act came into sharper focus Tuesday, with a new analysis projecting that higher premiums will cause millions more people to lose insurance this year.
Another sign of economic distress: Average deductiblesfor policyholders are now the highest ever, a result of people switching to the exchange’s cheapest “bronze plans” in response to premium hikes, according to the report released Tuesday by KFF, a health policy research organization.
With greater migration to bronze plans, the average deductible for ACA recipients rose more than $1,000 a year, to $3,786, the KFF analysis found.
There are two ways that people are losing coverage. First, premium increases prevented some from signing up during last year’s open enrollment period. Now, millions who did sign up can no longer afford the premiums and will lose coverage for failing to pay.
The impacts are a result of a deadlock in Congress last year over covid-era ACA subsidies set to expire starting this year. Republicans, who hold majorities in the House and the Senate, refused to extend the subsidies for 2026 despite months of wrangling and a 43-day government shutdown.
With premiums rising as much as 100 percent for some, about 1 million people opted out of coverage for 2026 during last year’s open enrollment period. The KFF analysis says attrition for failing to pay could grow throughout the year by up to 4 million more.
In all, active enrollment could fall from 22.3 million in 2025 to about 17.5 million in 2026, KFF said, citing a report by Wakely Consulting Group.
Enrollment declines were predicted last year by the Congressional Budget Office as bills to extend the special subsidies were debated. As 2026 began, the most dire forecasts did not immediately materialize. But analysts say the impact will unfold as people stop paying premiums over time.
“Some people dropped coverage altogether, other people are paying the higher premiums to keep their plans, and other people are dropping down to a plan that is kind of bare-bones and has a high deductible,” said Cynthia Cox, a KFF vice president and the director of KFF’s program on the ACA.
“The combination of all that is people are experiencing big cost increases,” she said.
People with no insurance or high deductibles are taking on more risk because of the high costs.
“On one side of the coin, people are not getting the care they need because they cannot afford it,” she said. “On the other side are people still needing care they cannot avoid, emergency care or a hospitalization, where they go into medical debt.”
The state with the biggest decline in enrollment as of the beginning of the year was North Carolina, which dropped about 214,000 people, or 22 percent, according to North Carolina Health News, which cited data from the Centers for Medicare and Medicaid Services.
“The storm is here, and that’s true across the country. It’s only going to intensify in the coming months as people can’t afford their premiums and they drop coverage,” said Jonathan Oberlander, a professor of health policy at University of North Carolina at Chapel Hill.
As costs rise and people across the country lose insurance, Democrats are using the ACA premium hikes against Republican House members in some of the tightest midterm races, covering districts in New York, Pennsylvania, Michigan, Wisconsin, Iowa and California.
In Arizona, another state that experienced a large decline in ACA enrollment to start the year, the progressive group Protect Our Care has targeted Rep. David Schweikert (R), who is running in the GOP primary for governor, leaving open his seat representing Scottsdale and other parts of metro Phoenix. The district is rated a toss-up by the Cook Political Report. Schweikert’s office did not respond to a request for comment.
A rise in uninsured people also will be fueled by mandatory eligibility verifications and work requirements for Medicaid that were part of President Donald Trump’s One Big Beautiful Bill, Oberlander said. Beyond the financial and health burdens for people who are uninsured, he said, the “double-whammy” of ACA and Medicaid reductions will have a big impact on some of the largest employers in local communities: health systems.
“Health care is a major industry in North Carolina and beyond,” he said. “There are major economic implications and political implications.”