Affordable Care Act enrollment could decline by around 5 million people this year after Congress failed to extend enhanced subsidies for insurance coverage at the end of 2025, according to a new analysis by KFF, a healthcare policy research group.
Initial sign-ups for Obamacare plans fell by more than 1 million to 23.1 million during the open enrollment period for 2026, KFF says. Actual enrollment may fall much further, though, based on reports about how many of those who signed up ultimately pay their premiums. Those premium payments have jumped by an average of 58%, from $113 to $178 per month, KFF finds.
Given the increased costs, the number of “effectuated” enrollments — people who have paid their premiums — could fall to around 17.5 million, or even as low as 16.5 million, compared to 22.3 million last year.
Out-of-pocket costs are also rising. The average ACA deductible has increased by 37%, the largest ever for ACA marketplace plans, going from $2,759 in 2025 to $3,387 in 2026.
Next year could be rough, too: Lower Obamacare enrollment could lead insurers to raise rates for 2027, especially if younger, healthier people drop their coverage, leaving an older, sicker pool to be insured.
Michelle Anderson, a director at Wakely Consulting Group who recently published a report on the early 2026 enrollment trends, told KFF Health News that she doesn’t expect premium rate increases next year to match those for 2026 and said that insurers “aren’t waving huge red flags” yet. Still, she said some price hikes could well be in the works: “It would not surprise me if there were some double-digit increases.”
