ACA Enrollment Drops Sharply as Premium Payment Rates Fall Across Multiple States
Affordable Care Act enrollment is dropping sharply after enhanced premium tax credits expired at the end of 2025. Georgia saw a 28% drop in premium payments in April 2026 versus April 2025. Wakely Consulting Group estimates average 2026 enrollment will be 17% to 26% lower than 2025. Premiums increased 26% on average while deductibles grew 37%, from $2,759 to $3,786, the steepest increase in history.
ACA enrollment decline
▪Wakely Consulting Group estimates that average Affordable Care Act enrollment will end up being 17% to 26% lower in 2026 than in 2025.
▪Affordable Care Act sign-ups were down in January 2026 by about 1.2 million from the 2025 record enrollment.
▪Michelle Anderson is a director at Wakely Consulting Group and co-author of a May 2026 report on Affordable Care Act enrollment trends.
▪Approximately 23 million people enrolled in the Affordable Care Act for 2026.
Premium payment failure rates
▪States served by the federal Affordable Care Act marketplace had premium payment rates of 82% to 84% in January 2026.
▪New Mexico was the only state in Charles Gaba's sample that saw an increase in the percentage of people making Affordable Care Act premium payments in 2026.
▪New Jersey had an 11.6% premium payment failure rate as of April 2026.
▪Georgia saw a 28% drop in people paying Affordable Care Act premiums in April 2026 compared with April 2025.
▪States that run their own Affordable Care Act exchanges had a 92% premium payment rate in January 2026.
▪NOTUS reported on May 12, 2026 that internal Centers for Medicare & Medicaid Services data showed roughly 21% of people using the federal Affordable Care Act marketplace in 30 states failed to pay their share of January 2026 premiums.
▪Washington state had a 15.7% premium payment failure rate as of February 2026.
▪New Mexico set aside state money to fully make up for lower federal Affordable Care Act subsidy amounts in 2026.
▪An average 86% of Affordable Care Act enrollees made their first premium payment in January 2026, according to Wakely Consulting Group analysis of data from 75 insurers.
Premium increases
▪Affordable Care Act enrollees faced premiums that increased on average by 26% in 2026.
Deductible increases
▪A KFF analysis released on May 19, 2026 found that the average Affordable Care Act plan deductible grew by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026.
▪Sign-ups for bronze-level Affordable Care Act plans jumped from 30% to 40% of total plan selections, growing from 7.3 million in 2025 to 9.2 million people in 2026.
Insurer rate projections
▪Many of the Trump administration's proposed 2027 Affordable Care Act changes were approved with some modifications, including allowing for higher annual deductibles in some types of coverage.
▪Michelle Anderson of Wakely Consulting Group does not expect an average 26% premium increase for 2027 like the one seen in 2026.
▪The Trump administration released the initial 2027 Affordable Care Act proposal in mid-February 2026 and did not finalize it until May 15, 2026.
▪Michelle Anderson of Wakely Consulting Group expects ongoing uncertainty and predicted decline in Affordable Care Act enrollment to play a role in setting 2027 premium rates.
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