Affordable Care Act (ACA) marketplace enrollment could fall sharply in 2026 after enhanced federal premium subsidies expired at the end of last year, according to a report published Tuesday by health policy research group KFF.
The Affordable Care Act marketplace, commonly known as Obamacare, provides government-subsidized health insurance coverage for millions of Americans who do not receive insurance through employers.
KFF estimated average ACA marketplace enrollment could fall to around 17.5 million people in 2026 from 22.3 million in 2025, with higher insurance costs pressuring consumers. The group also warned that many enrollees may drop coverage or fail to pay premiums during the year as affordability pressures intensify.
Average monthly premium payments rose 58% year-over-year from $113 to $178 after enhanced pandemic-era tax credits expired, while average deductibles jumped 37% to a record $3,786 in 2026.
KFF said more consumers shifted toward lower-premium bronze plans, which generally carry higher out-of-pocket medical costs. Bronze-plan selection rose to a record 40% in 2026 from 30% a year earlier, while silver-plan enrollment fell to a record low.
