The New Numbers Just Dropped — And They're Bad

KFF, a nonpartisan health policy research nonprofit, published its analysis on Tuesday. The headline: ACA marketplace enrollment may fall by roughly 5 million people in 2026, dropping from 22.3 million participants in 2025 to approximately 17.5 million — a 21.5% decline, according to KFF.

KFF's analysis draws on federal enrollment data and premium payment estimates from Wakely Consulting Group, a healthcare actuarial firm with direct access to insurance industry data. Wakely's own estimate is even grimmer — they peg the potential decline at up to 26%, according to the New York Times.

The federal government has NOT yet released official 2026 enrollment figures. Every number right now is an estimate.

What Changed Since Our Last Coverage

We already covered the subsidy expiration and the initial 1.2 million drop in sign-ups at open enrollment. Insurers, state officials, and analysts are now tracking a second wave of dropouts — people who initially kept their coverage after auto-renewal but are now canceling mid-year as the bills pile up. This is the part the initial enrollment numbers didn't capture.

Cynthia Cox, who co-authored the KFF report, put it plainly: "People are trying to hang on to their health insurance coverage any way they can, even if that means they have a deductible of $7,000."

A $7,000 deductible means you're essentially uninsured for anything short of a hospitalization.

Premiums Didn't Double — But Not for a Good Reason

KFF had previously projected that average ACA premiums could spike 114% after the enhanced subsidies lapsed, according to CNBC. The actual average increase came in at 58%.

Premiums rose "only" 58% because millions of Americans downgraded to cheaper plans with dramatically higher deductibles and less coverage. Average deductibles climbed by more than $1,000. Monthly premium payments rose an average of $65 per month, according to KFF.

"No matter how you slice it, people are paying more," Cox said.

The premium number looks better on paper because people absorbed the cost shock by gutting their coverage. People are paying more — they're just buying less.

Who's Getting Hit Hardest

Middle-income Americans are taking the worst of it. KFF specifically flags this group: they earn too much to qualify for the remaining low-income subsidies, but not enough to comfortably absorb a $65/month premium hike plus a $1,000 deductible increase.

The ACA marketplace primarily serves gig workers, farmers, ranchers, hairstylists, and the self-employed — people who built their financial lives around a marketplace that just got significantly more expensive overnight.

What the Left-Leaning and Right-Leaning Coverage Are Each Getting Wrong

The New York Times frames this almost entirely as a Republican failure — Congress "failed to extend" subsidies, health care will "figure prominently in midterm elections." The political threat to Republicans is front and center. The underlying policy question — whether $54 billion per year in enhanced subsidies was a sustainable permanent fixture — gets zero scrutiny.

ZeroHedge and American Greatness, on the other hand, lean into the "Obamacare collapsing" framing without engaging seriously with what that means for the actual farmers and self-employed workers who relied on it.

Neither side is asking the real question: What's the actual plan going forward?

CNBC notes that President Trump and congressional Republicans have floated alternatives — direct payments to households for health expenses and expanded health savings accounts. Those ideas have NOT moved through Congress. They are not policy. They are talking points.

The Trump Administration's Counter-Argument

Federal officials have stated that part of the enrollment decline reflects removal of fraudulent and improper enrollments from the ACA system — not just people losing coverage they actually wanted. The Trump administration has pointed to this as a cleaning of the rolls.

That may be partially true. It is also convenient. Without official federal enrollment data — which has NOT been released — it's impossible to quantify how much of the decline is fraud cleanup versus real people losing real coverage.

The administration owes the public those numbers. Now.

What This Means for Regular Americans

If you're self-employed, a freelancer, or running your own small business, your health insurance just got 58% more expensive on average — and that average is being dragged down by people who downgraded to plans with $7,000 deductibles.

Health care costs are already the top financial concern among American households, according to multiple public opinion polls cited by the New York Times and CNBC.

Midterm elections are coming. Both parties know this issue is live ammunition. Republicans have no concrete replacement policy on the table. Democrats want to restore subsidies that cost tens of billions annually with no long-term funding mechanism.

Neither side has a plan that actually makes health care cheaper. They have plans that shift who pays for it.

Meanwhile, 5 million people may end the year without coverage. That's a number.