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One (Maybe Two) Big Things:
The enhanced premium tax credits expired at the end of 2025, thanks to the “One Big Beautiful Bill Act”. As a result, ACA monthly premiums have soared an average of 58% from 2025 to 2026. ACA insurers also raised premiums in 2026 by an average of 18%, with another 14% raise expected in 2027. Plus, ACA plan deductibles rose about 37%, or more than $1,000 per individual policy on average.
Older and middle-income adults will be hit the hardest because of the “subsidy cliff”, which leaves all ACA enrollees making 400% or more of a state’s poverty level ($62,600—$63,840 for an individual) without any government subsidies to help pay premiums.
Analysis of data gathered by the Kaiser Family Foundation (KFF), the Center for Medicare and Medicaid Services and other organizations show a precipitous drop in 2026 enrollment within the ACA marketplace, largely attributable to the shocking increase in insurance premiums from both insurer premium increases and loss of premium insurance credits, together with rising deductibles for various policies:
Based on reports to date of sign-ups and premium payments, average monthly effectuated ACA Marketplace enrollment could fall to about 17.5 million people in 2026 and could be as low as 16.5 million people, down from 22.3 million people in 2025.
Premium payments from enrollees increased by an average of 58% from $113 to $178 per month. This is lower than the 114% increase KFF projected if everyone had stayed in the same plan because many people bought down to higher-deductible plans and because those just past the subsidy cliff with the steepest increases dropped ACA coverage at higher rates.
Average ACA Marketplace deductibles increased by 37% (or $1,027 per person) to a record high of $3,786 in 2026. This is the steepest increase in deductibles ever seen in this market and largely reflects the shift from silver plans with reduced deductibles for lower-income enrollees to bronze plans with very high deductibles.
A report published by Wakely Consulting Group early this year analyzed the impact of falling enrollment in the ACA market place. Although the reduction in enrollment so far in 2026 was less than projected in 2025, many who stayed with an ACA plan traded premium costs for higher deductibles by switching from higher cost plans like the most popular Silver tier, to Bronze plans with lower out-of-pocket premiums and less coverage, but much higher deductibles.
The Wakely report also projected additional enrollment losses throughout this year:
Effectuated enrollment (the number of people who pay premiums and maintain effective coverage) is expected to fall even further than previous years as 2026 unfolds and many enrollees are unable to afford higher premium payments without enhanced tax credits, signaling significant mid-year attrition on top of already declining sign-ups.
Why It Matters:
The massive jump in 2026 premiums and deductibles for health insurance purchased through the ACA Market Place (with another planned 14% increase in 2027) is not affordable for tens of millions of Americans, now or in the future. These individuals and families with children already have dropped health insurance altogether, or switched to ACA plans that have less coverage and higher deductibles, setting them up for massive medical debt if they dare to get sick or have an accident.
When adults are sick and can’t receive medical treatment, they work less, maybe even get fired from their jobs, qualify for other types of government assistance, burden already overcrowded emergency rooms and contribute much less to the overall economy.
And they will die. The U.S. Senate Committee on Finance says that 8, 811 Americans will die each year from this Administration’s failure to extend the ACA premium tax credits, alone.
Here’s more on what the U.S. Senate Committee on Finance had to say about American deaths resulting from this year’s changes to the ACA, after analyzing studies conducted by the University of Pennsylvania’s Leonard Davis Institute of Health Economics (Penn LDI) and the Yale School of Public Health’s Center for Infectious Disease Modeling and Analysis:
11,300 deaths per year from the loss of Medicaid or Affordable Care Act Marketplace coverage due to 7.7 million people losing coverage.
18,200 deaths per year due to the loss of Medicaid coverage among 1.38 million low-income Medicare beneficiaries, causing loss of access to low-income prescription drug assistance.
13,000 deaths per year among Medicaid enrollees in nursing homes due to the rollback of the 2024 nursing home minimum staffing rule.
8,811 deaths per year from the proposed bill’s failure to extend the enhanced ACA premium tax credits.
What We Must Do:
We must expand Medicare to cover every American citizen and those people living in the United States legally. We also must expand Medicare to include dental, vision, hearing and full coverage of prescription drugs. There must be no more subsidies paid by taxpayers to insurance companies in a vain effort to keep prices down and keep their profits up, no uninsured people, no one forced to declare bankruptcy for medical debt only billionaires could pay, and most importantly, no one dying because they can’t afford health care.
This is the least we must do in the wealthiest country on Earth.
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The question for this post is: Are you in favor of an expanded Medicare system that covers all of our citizens and legal residents? Please feel free to leave any thoughts and ideas in the Comment Section below. And please don’t forget to share, like and restack this post as you can—every share helps grow our Poverty Trap community—thanks!
