Overview
- Congress let the enhanced premium tax credits that began in 2021 expire at the end of 2025, and the resulting higher monthly costs have reduced affordability for many marketplace buyers.
- Researchers report a national shortfall of roughly 1.5 million fewer marketplace signups in 2026 versus 2025 and a sharp rise in plan cancellations and unpaid premiums.
- State data show large, localized losses with Pennsylvania reporting about 160,000 canceled plans and Illinois showing more than 92,000 people off coverage, most for nonpayment.
- Enrollees who remain are shifting to lower-value plans, with Bronze plan share rising while Silver plan share falls, increasing the risk of underinsurance and a weaker risk pool.
- Six insurers have announced they will leave some or all ACA marketplaces for 2027, and analysts say only federal action to restore subsidies or major state offsets can meaningfully reverse the trend.