News|Articles|June 9, 2026

ACA Enrollment Erosion Deepens After Open Enrollment Ends

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Key Takeaways

Early state-based marketplaces report markedly higher post-enrollment cancellations, suggesting national attrition may be worse in federally facilitated states lacking supplemental affordability programs.
Affordability shocks from subsidy expiration disproportionately affected middle-income and Black consumers in California, whereas state-funded subsidies stabilized retention among the lowest-income enrollees without racial/ethnic gaps.
Benefit design is deteriorating as enrollees trade down to bronze plans, reducing actuarial value and increasing underinsurance risk; average deductibles rose about $1,000 to >$3,800.
First-month premium nonpayment doubled historically to ~14%, implying healthier members may exit early and worsening risk-pool morbidity, with projected 2026 enrollment losses near 5 million and further 2027 declines.

State data reveal 2026 ACA marketplace enrollment losses are accelerating post open enrollment, as cancellations surge and affordability pressures mount after tax credits expired.

Affordable Care Act (ACA) marketplace enrollment losses that began during the 2026 open enrollment period have continued to widen in the months since, with emerging state-level data revealing sharp spikes in plan cancellations and premium nonpayment that signal a steeper national coverage decline than initial sign-up figures suggested, according to a new analysis published in the Commonwealth Fund's To the Point blog.¹

What State-Level Data Reveal After Open Enrollment

The analysis draws on early enrollment data released by several state-based marketplaces through April 2026. These figures capture a critical postenrollment window after automatic renewals and initial sign-ups, but once first premium bills arrive and grace periods begin to expire.

Plan cancellations across the reporting state marketplaces rose 24% between January and March of this year compared with 2025. Maryland offers a particularly striking example, as the state typically sees a 3% drop-off between open enrollment and April, but in 2026, that figure jumped to 13%. The authors note that the reporting states tend to invest their own funds in coverage affordability initiatives, meaning national outcomes across the majority of states that lack such programs could look substantially worse.

The pattern was not uniform across income levels. California's marketplace examined who was driving cancellations and found that middle-income consumers who lost financial assistance when enhanced premium tax credits expired were canceling at twice the rate seen last year. Black consumers were similarly canceling at double last year's rate. By contrast, the lowest-income enrollees, shielded by state-funded subsidies, were less likely to drop coverage and showed no racial or ethnic disparity. This finding may point toward the fact that affordability, not other factors, is the primary driver.

How Expired Tax Credits Are Reshaping Plan Selection

Beyond outright cancellations, the analysis also documents a broad migration toward lower-value coverage—a trend with significant implications for out-of-pocket costs and underinsurance. Enrollment in bronze-tier plans climbed from 30% of marketplace selections in 2025 to 40% in 2026, while silver-tier enrollment fell correspondingly. The average marketplace annual deductible increased by approximately $1000 year over year, reaching over $3800.

As previously reported by The American Journal of Managed Care^® (AJMC^®), a KFF analysis documented the same bronze-plan migration and linked it to the expiration of enhanced subsidies. The average effectuated enrollment could fall 21.5% from 22.3 million in 2025 to roughly 17.5 million.²

The downstream consequences for managed care stakeholders are significant. Enrollees in high-deductible bronze plans face greater barriers to accessing care before meeting their deductible, are more likely to delay or forgo needed services, and carry elevated exposure to medical debt. Approximately 14% of January 2026 enrollees did not pay their first monthly premium, which is roughly double the historical rate, suggesting that adverse selection dynamics are already beginning to shape the risk pool, with healthier individuals disproportionately exiting coverage.³

What Comes Next for Marketplace Stability

Analysts project that full-year 2026 marketplace enrollment will decline 17% to 26% from 2025 levels, a loss of approximately 5 million people.¹ That trajectory is expected to worsen in 2027, when additional federal subsidy reductions and new administrative enrollment barriers enacted in the 2025 tax-and-spending law are scheduled to take effect.

Federal regulators have not yet released a nationwide snapshot of paid enrollment data, but that figure is expected this summer and will provide the first comprehensive view of how many sign-ups translated into active, effectuated coverage.

For health plans, hospital systems, and managed care organizations operating in the individual market, the emerging data reinforce that the coverage disruption is not contained to the open enrollment period. Ongoing monitoring of effectuated enrollment, plan mix, and cost-sharing exposure will be essential to forecasting actuarial risk and anticipating demand patterns across the remainder of 2026.

References

Pogue S, Corlette S. Emerging state data paint a bleak picture of 2026 marketplace enrollment. Commonwealth Fund. June 8, 2026. Accessed June 9, 2026. https://doi.org/10.26099/Z83F-7J56
Grossi G. ACA Marketplace deductibles surge $1000 in 2026 as enhanced tax credits expire. AJMC. May 20, 2026. Accessed June 9, 2026. https://www.ajmc.com/view/aca-marketplace-enrollment-and-affordability-take-historic-hit-as-enhanced-tax-credits-expire
Bonavitacola J. Percentage of enrollees who fail to make ACA payments rises to 14%. AJMC. April 15, 2026. Accessed June 9, 2026. https://www.ajmc.com/view/percentage-of-enrollees-who-fail-to-make-aca-payments-rises-to-14-