ACA enrollment set to fall by 5 million as premiums surge

A new analysis by the health‑policy nonprofit KFF projects that enrollment in the Affordable Care Act health‑insurance marketplace could drop from 22.3 million in 2025 to about 17.5 million this year, a decline of more than 20%. The shrinkage is driven by rising costs after the expiration of COVID‑era subsidies on Jan. 1, which has pushed average monthly premiums up $65 and average deductibles up by more than $1,000.

Middle‑income Americans are being hit hardest, as they earn too much to qualify for remaining low‑income subsidies yet cannot comfortably afford the higher premiums. States that run their own exchanges have retained a larger share of enrollees than those relying on the federal marketplace. Insurers say they have adjusted offerings, potentially limiting further premium spikes, but the enrollment drop could become a significant issue in the upcoming midterm elections.