KFF published an analysis on May 19, 2026 showing ACA Marketplace coverage under major strain after enhanced premium tax credits expired at the end of 2025. KFF estimated average monthly effectuated Marketplace enrollment could fall to roughly 17.5 million people in 2026, and potentially as low as 16.5 million, compared with 22.3 million in 2025.
The report also found enrollee premium payments rose by an average of 58%, while average Marketplace deductibles increased by 37% to a record $3,786 per person.
For patient advocates, the story is not only premiums—it is whether people can maintain coverage and afford to use it. Higher deductibles can mean delayed specialist visits, postponed diagnostic tests, skipped prescriptions, and more medical debt.
What advocates should watch
Track mid-year attrition, state-level differences, and whether enrollees shift into lower-premium plans that expose them to higher out-of-pocket costs when they need care. Cancer, chronic disease, rare disease, disability, and low-income access groups should pair enrollment data with stories about foregone treatment.
Related: KFF analysis.
Counseling marketplace enrollees
Compare total cost—not premium alone—when enhanced subsidies lapse. High deductibles can shift affordability even if the monthly premium looks manageable on paper.
Screen clients for Medicaid, CHIP, or employer coverage changes at renewal, and document special enrollment period triggers if income or household size changes midyear.
Guides on patientadvocates.io
For step-by-step help, start with our Employer plans guide or browse related topics including Appeals roadmap, Rx affordability.