Percentage of Enrollees Who Fail to Make ACA Payments Rises to 14%

About 14% of individuals who were enrolled in Affordable Care Act (ACA) plans were not able to meet their first payment in the new year, according to a new analysis published in The Wall Street Journal.¹ The results of the survey and analysis, conducted by actuarial firm Wakely Consulting Group, corroborate previous findings that have showed that Americans are finding it difficult to pay for health care after the expiration of enhanced subsidies under the ACA.

The survey was conducted by drawing on insurers who represented enrollment in 30 states, making up about 80% of the country’s insurance enrollment. The data were collected through the end of January; states included in the analysis were not specified.

According to the survey results, about 1 in 7 people who signed up for a plan under the ACA were not able to pay their first monthly bill for January coverage, a notable increase compared with the mid-single-digit range that is normally seen. Those who signed up with the same insurance under the ACA as the previous year were about 10% less healthy compared with those who did not pay their January bills, based on their expected health care costs, as healthier people leaving the market drives up premiums overall.

The data varied by state, with some states reporting that everyone who was covered through the ACA was able to pay their first premium bills. Higher rates of nonpayment were found in states that used the federal online marketplace rather than offering their own. States that automatically re-enrolled residents in their coverage saw larger drop-offs in being able to pay for their monthly premium.

These results show a trend around the country, as cost concerns have plagued Americans since the enhanced subsidies expired at the end of 2025. A KFF survey found that 80% of those who had re-enrolled in ACA Marketplace coverage reported higher health care costs compared with last year, with a little more than half reporting much higher costs.² The survey had also found that 73% of Marketplace enrollees were very or somewhat worried about affording their monthly premiums with the expiration of the enhanced subsidies. Enrollees expressed that they would be cutting back on spending for food or basic household items to continue to afford their health care coverage.

With the expiration of the subsidies in 2025, the House has passed a bill that would allow for a 3-year extension of the enhanced subsidies in a 221-205 decision.³ However, the bill has not been voted on in the Senate, putting the fate of the enhanced subsidies in limbo as Americans on Marketplace plans feel the effects of the expiration of these subsidies.

Overall, Americans are facing challenges in being able to pay for their health care coverage if they get it through the ACA Marketplace. Enrollment in the ACA Marketplace is down from more than 24 million in 2025 to 23 million in 2026,¹ which could continue to drop off as prices continue to rise for health care. Wakely projects that ACA enrollment will likely sink by 17% to 26% compared with last year due to this rise, leaving millions of people without insurance in the future and indicating an area of focus in the future.

References

1. Wilde Mathews A. Around 14% of enrollees in ACA plans failed to make payments, data shows. Wall Street Journal. April 15, 2026. Accessed April 15, 2026. https://www.wsj.com/health/healthcare/around-14-of-enrollees-in-aca-plans-failed-to-make-payments-data-shows-6971b363
2. Lopes L, Valdes I, Sparks G, Mulugeta M, Kirzinger A. Cost concerns and coverage changes: a follow-up survey of ACA Marketplace enrollees. KFF. March 19, 2026. Accessed April 15, 2026. https://www.kff.org/public-opinion/a-follow-up-survey-of-aca-marketplace-enrollees/
3. Bonavitacola J. House votes to extend ACA subsidies, eyes turn to Senate. AJMC^®. January 8, 2026. Accessed April 15, 2026. https://www.ajmc.com/view/house-votes-to-extend-aca-subsidies-eyes-turn-to-senate