The Affordable Care Act (ACA) is facing a significant challenge as enrollment continues to erode, with a 28% drop in Georgia alone, according to healthcare policy analyst Charles Gaba. This trend is causing market uncertainty for insurers, who are likely to raise rates again next year, following this year's larger-than-usual hikes. The initial results come amid rising public concern about affordability, with polls showing healthcare costs are a top priority for voters. The average ACA plan deductible saw the steepest increase in history, growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired. This poses a political challenge for President Trump and the broader GOP, which has opposed enhanced subsidies to help people purchase Obamacare coverage. The enrollment reductions are real people with real consequences, said Montz. The individual market is trending toward a significant contraction in 2026, and may well resemble drops projected by the Congressional Budget Office. Wakely Consulting Group estimates that average ACA enrollment will end up being 17% to 26% lower this year than last. The drop-off rate aligns with what some policy experts predicted, partly because Congress did not extend generous benefits that expired at the end of last year. Some people had never experienced the ACA before the enhanced tax credits kicked in, so they faced extra sticker shock. The expectation of a lower enrollment trend holding up is one of the key factors likely to translate into higher cost estimates as insurers draw up 2027 rates. The Trump administration ended a special enrollment program that let low-income people enroll year-round. Some ACA critics say enrollment drops should not be seen solely in the context of rising costs. Paragon Health Institute, a free-market think tank, has argued that record enrollment numbers in recent years were fueled by fraudulent sign-ups, perhaps in the millions. Insurers, hospitals, and policy experts took issue with the methodology Paragon used to estimate improper enrollments, saying they likely were vastly overestimated. The biggest explanation for falling enrollment is cost, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. The Trump administration's proposal for 2027 came out in mid-February and included aggressive new ideas, such as sharply increasing deductibles for certain types of ACA plans or allowing insurers to offer plans with no set networks of medical providers. It was not finalized until May 15, well into the time when insurers are calculating premiums for the following year. Many of the proposed changes, with some modifications, were approved, such as allowing for higher annual deductibles in some types of coverage. This is definitely a challenging year to be an actuary, said Louise Norris, a health policy analyst for healthinsurance.org. While they aren't waving huge red flags yet, insurers are closely watching trends, said Michelle Anderson, a director at Wakely and co-author of the recent report. Anderson does not expect an average 26% premium increase like the one seen this year. Still, Anderson expects the ongoing uncertainty and predicted decline in enrollment, which will vary by state and insurer, to play a role in setting next year's premium rates. KFF Health News reporter Rachel Spears contributed to this article.
