After Washington let Obamacare’s enhanced subsidies expire, millions of working Americans are now staring down premium hikes so steep that many say they’d rather go uninsured.
Quick Take
- Enhanced ACA premium tax credits expired January 1, 2026, driving major out-of-pocket premium increases for many subsidized enrollees.
- KFF estimates that for subsidized enrollees who keep the same plan, premium payments rose about 114% on average in 2026.
- CMS reported roughly 23 million Marketplace plan selections for 2026—down more than 1 million from about 24.2 million at the same point in 2025.
- A KFF poll found about 25% of enrollees would forgo coverage entirely if premiums doubled, underscoring how price-sensitive the system has become.
Subsidy expiration collides with family budgets
Congress’s failure to extend the enhanced premium tax credits ended a major affordability backstop that had been in place since 2020. When the credits expired on January 1, 2026, many Marketplace households faced sharply higher monthly bills. KFF’s analysis puts the average premium-payment increase for subsidized enrollees who keep the same plan at roughly 114%, turning coverage into a budget crisis for families already squeezed by broader cost pressures.
KFF’s polling and related reporting describe how enrollees respond when health insurance competes with groceries, rent, utilities, and car payments. The top-line warning is blunt: about one in four Marketplace enrollees say they would drop coverage if premiums doubled. That kind of response is less about politics than arithmetic—when government policy shifts quickly, households with limited room to maneuver start cutting essentials or walking away from coverage.
Enrollment is down, and the biggest drop may be delayed
CMS’s early 2026 figures show about 23 million consumers selecting plans across the federal and state Marketplaces—about 15.8 million through HealthCare.gov and about 7.2 million through state-based exchanges. That’s more than a 1 million decline compared with about 24.2 million at the same point in 2025, marking the first apparent sign-up decline since 2020 as the subsidy era ended and sticker shock returned.
Those headline numbers also come with an important limitation: they represent plan selections and automatic renewals, not “effectuated” enrollment—people who actually pay the first premium and keep the policy active. KFF cautioned that effectuation could be weaker this year because many automatically renewed households may not realize how much their bill changed until the invoice arrives. With payment deadlines stretching into early March for some enrollments, a second wave of drop-offs is still possible.
State stopgaps show what limited government can and can’t fix
State-level exchanges and premium assistance programs can soften the blow, but they cannot fully replace a large federal subsidy structure once it disappears. Maryland’s Health Benefit Exchange has publicly described consumers “buying down” to less expensive coverage options as prices rise, a practical sign that families are trading benefits and provider access for lower premiums. The lesson for policymakers is that small, targeted state help may slow attrition, but it won’t erase nationwide affordability gaps.
What this means for healthcare access—and for taxpayers
Higher premiums and declining enrollment typically push more people into the uninsured category, increasing delayed care and financial risk when illness or injury hits. The political debate is already re-emerging in familiar terms: Democrats argue subsidies protect access, while Republicans have long warned about long-run taxpayer exposure and dependency on federal spending to prop up enrollment. The 2026 data adds a hard constraint to both sides—if coverage only “works” when Washington spends more, the system’s design remains fragile.
Final, confirmed enrollment will not be known for months, and the full-year 2026 effectuated data is expected much later. For now, the strongest verified signals are the ones already published: a measurable decline in plan selections, unusually large average premium-payment increases for many subsidized households who stayed in place, and survey evidence that a sizable share of enrollees will walk away if costs jump again. That is the opposite of “affordable,” and it’s a warning sign voters will keep pressing leaders to address.
Sources:
What Americans are giving up to afford ACA health insurance, according to a new poll
Obamacare enrollment fell more than 1M enrollees in 2026
ACA marketplace enrollment is down in 2026, but all of the data isn’t in yet
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