The Affordable Care Act Marketplaces are undergoing significant shifts that are reshaping the landscape for millions of enrollees. Recent developments paint a complex picture of rising costs, enrollment losses, and a fundamental transformation in how people access coverage.

The Premium Shock

Enrollees faced a major jolt when enhanced premium tax credits expired in January 2026. These subsidies had helped millions afford their insurance, and their loss triggered immediate consequences. Preliminary rate filings suggest insurers are proposing a median premium increase of 14% for 2027. If these increases hold, typical premiums would jump by more than one-third between 2025 and 2027. This represents a likely second consecutive year of double-digit increases, signaling that affordability pressures are intensifying rather than easing.

Enrollment Numbers Tell the Story

The marketplace lost 3 million people so far this year following the expiration of enhanced credits. Enrollment dropped 13% from a high of 22.1 million in 2025 to 19.2 million in February 2026. These numbers reflect the real impact of premium increases on household budgets. When people face steep increases in their premium payments—often double or triple digits—many make the difficult decision to drop coverage entirely.

Deductibles Are Getting Worse

Beyond premiums, deductibles are creating a second affordability crisis. The average ACA Marketplace deductible grew by 37% or over $1,000, jumping from $2,759 in 2025 to $3,786 in 2026. This steepest increase in history came as enhanced credits expired and enrollees scrambled to find more affordable options.

In response, many marketplace shoppers shifted toward lower-premium, higher-deductible plans. Sign-ups for bronze plans jumped from 30% to 40% of total plan selections between 2025 and 2026, growing from 7.3 million to 9.2 million people. This means enrollees are trading lower monthly premiums for higher out-of-pocket costs when they actually need care.

The Affordability Squeeze on Households

Returning enrollees reported that their health care costs have become significantly more burdensome. Half said their costs are “a lot higher,” and most expected to cut back on basic household expenses to afford coverage. This reflects a broader affordability crisis that extends well beyond marketplace enrollees.

What’s Ahead

Several health insurers have announced they will exit state ACA Marketplaces next year, potentially leaving hundreds of thousands of enrollees with fewer insurance options. The landscape continues to shift as carriers reassess their participation amid rising medical costs and enrollment pressure.

The marketplace that was designed to make health insurance more accessible is facing a critical affordability test. Premiums are climbing, deductibles are soaring, and millions of people are responding by dropping coverage altogether. The next phase of the ACA’s evolution will be defined by whether policymakers can address the underlying cost pressures driving these increases.