Medical costs could skyrocket as ACA subsidies expire
Millions are at risk of skyrocketing health costs in 2026 if Congress fails to extend health care subsidies.
The expiration of the Affordable Care Act’s enhanced subsidies leaves millions of Americans who wanted to maintain insurance in 2026 with expensive options. Stay with the intermediate Silver plan and pay a higher monthly fee, or downgrade to less expensive coverage.
An analysis released May 19 suggests that many people switched to plans with lower monthly premiums, but higher deductibles, or the amount they must pay before most coverage kicks in.
The average deductible for ACA plans will reach $3,786 in 2026, an increase of more than $1,000 from the previous year, according to the health policy nonprofit KFF.
Nearly 4 million Americans have left mid-tier silver plans, with a total of 9.8 million enrollees, according to KFF. Meanwhile, enrollment in lower-level bronze plans reached 9.2 million, up nearly 2 million from a year ago.
How many Americans will lose their ACA coverage?
It’s still unclear how many Americans have already opted out or are planning to opt out of the ACA, known as Obamacare.
The Centers for Medicare and Medicaid Services reported on January 28 that approximately 23 million Americans will be enrolled in ACA insurance in 2026, down from 24.2 million in January 2025.
However, these numbers also include many people who were automatically re-enrolled. If these consumers don’t pay their monthly premiums, which KFF says will increase by an average of 58% in 2026 without enhanced subsidies, their coverage will eventually be cut off. CMS is not expected to report these numbers until later this year.
About 86% of enrollees paid their monthly premiums in January, according to Wakely Consulting Group. The consultant analyzed data from insurance companies in more than 30 states and estimated that ACA enrollment this year will be 17% to 26% lower than last year.
KFF predicted that nearly 5 million people will drop their ACA coverage this year. KFF’s analysis was based on Wakeley’s estimates and federal data.
Cynthia Cox, KFF’s vice president and ACA program director, said the coverage losses “seem to be what people expected.” “That means millions of people could drop their ACA coverage because the premium tax credit will not be strengthened.”
But some critics of the ACA say other factors may be to blame for the decline in enrollment. Paragon Institute, a conservative think tank, said tougher premium subsidies and lax oversight during the coronavirus pandemic may have facilitated millions of fraudulent registrations.
Beyond ACA coverage, Americans are widely concerned about health care costs as they struggle to pay for other living expenses, such as rising gas prices and housing costs.
According to an April Gallup poll, 6 in 10 Americans worry they won’t be able to cover their medical bills if they have a serious accident or illness. Almost half are concerned about day-to-day costs.
Couple refrains from restaurants and vacations due to Obamacare costs
Some people are struggling to pay for ACA insurance because their monthly bills are significantly higher.
In 2025, Kelly Berry and her husband, who live in Wisconsin, had an individual bronze insurance plan with a fully subsidized $7,500 deductible. This year, they’re paying a total of $2,300 a month for a plan with an $8,000 deductible.
Berry and her husband are self-employed, but their income is slightly too high to qualify for ACA subsidies, which are meant for people with incomes up to four times the federal poverty level.
Berry said she’s keeping her bronze-level plan because “I can’t find a cheaper plan and I’m not going to go without insurance.”
But she said it’s a struggle. Eliminated landscaping costs such as removing dead bushes and trees from the garden. They have no vacation plans other than visiting their elderly parents. They avoid eating out and scrutinize every grocery bill.
“It’s not an easy way to cut expenses and find that extra $2,300,” Berry says. “Every time we pay a bill, such as a mortgage, credit card, or health insurance premium, we need to monitor our bank accounts to make sure the money we need is in the right place.”
