Enrollment in the Affordable Care Act (ACA) has declined significantly this year, raising concerns about rising insurance costs and affordability. About 1.2 million fewer people signed up in January compared to last year, and preliminary data suggests a further drop as premiums increased by an average of 26%. The decline is attributed to the expiration of enhanced premium tax credits, which helped keep costs down for many enrollees.
Early data indicates that roughly 21% of federal marketplace enrollees failed to pay their January premiums, a sharp increase from previous years. States like Georgia saw a 28% drop in premium payments in April compared to the same period last year. Experts warn that the trend will likely worsen due to higher costs and reduced subsidies.
The decline in enrollment could lead to further premium hikes next year, as insurers face market uncertainty. A KFF analysis projects that enrollment may drop from 22 million in 2025 to 17 million in 2026, with many of those who leave the market becoming uninsured. Polls show that healthcare costs remain a top concern for voters, amplifying the political and economic stakes of the ACA's affordability challenges.