5M people may drop coverage from ACA marketplaces: Analysis

Roughly 5 million people could lose coverage from the Affordable Care Act Marketplace this year after the enhanced premium tax credits expired in 2025, according to the latest analysis from KFF. Last year marked four consecutive years of record growth in enrollment from the ACA Marketplace, due in large part to the enhanced premium tax credits making monthly costs more affordable for families, with plans in many cases offering $0 premiums. By the end of 2025, however, a deal to extend credits failed to come together, and Congress appears to have largely moved on from talks of reviving them. Enrollment fell for the first time in four years in 2026, with about 1.2 million fewer people signing up for coverage. This number is expected to grow throughout the year as households struggle to keep up with higher premiums. KFF’s latest analysis, released Tuesday, estimates that around 4.8 million to 5.8 million people could lose coverage, with a significant portion of these people being those just above the “subsidy cliff.” “Overall, consumers with incomes known to be above the subsidy cliff made up just 7% of 2025 enrollment but nearly half (48%) of the decline in plan selections from 2025 to 2026. (There are about 1 million consumers for whom household income is unknown, so the actual share of consumers who are above the subsidy cliff may be higher.),” KFF’s analysis found. Marketplace plan selections fell in 41 states, with North Carolina, Ohio and Indiana being among those that saw the highest drops in enrollment. Average monthly premium payments have also risen by 58 percent, going up by $65 on average. Overall, adults 18-34 years old represented the age group with the largest decrease in enrollment. Analysts had predicted that younger people would be most impacted by the tax credits expiring because they are less likely to have stable coverage through an employer. When the Centers for Medicare and Medicaid Services (CMS) released ACA enrollment figures in March, the agency appeared to suggest the drop in sign-ups was due in part to the administration’s crackdown on fraud. “In 2025, CMS took significant enforcement action to identify and remove improper enrollments, protecting taxpayers and consumers: we ended advance payment of the premium tax credit (APTC) or coverage for nearly 1.5 million people found to be either ineligible for financial assistance, or enrolled without their authorization on the HealthCare.gov platform,” CMS wrote in its press release.