As many have feared, policies coming out of Washington, D.C., have led to spiking healthcare costs for the more than 20 million people who rely on Affordable Care Act health insurance. Now, a new study confirms a worst-case scenario in which millions of people are simply dropping their healthcare coverage altogether, a scenario that creates risks for uninsured individuals and potentially adds to rising costs for those who keep their insurance.

Millions drop ACA healthcare coverage in the face of rising prices

A new report by the independent health policy research firm KFF indicates that enrollment in Affordable Care Act (ACA) healthcare plans is likely to drop from 22.5 million people in 2025 to only 17.5 million in 2026.

KFF paints a picture of rapidly rising ACA costs, most notably because subsidies that had been in place since 2021 were allowed to expire at the end of 2025. KFF says that, under these circumstances, millions of people are dropping their plans.

Open Enrollment Period signups for 2026 have already dropped by more than 1 million people compared to last year, and KFF estimates that another 4-5 million people will drop their plans or fail to pay their premiums this year.

This estimate comes from analyzing KFF survey data, as well as a wide variety of other sources, including reports from the Centers for Medicare & Medicaid Services and open enrollment reports from various state-based marketplaces, plus data from the Wakely Consulting Group.

Soaring healthcare costs after ACA subsidies ended

Cynthia Cox, a senior vice president of KFF who directs the organization’s Program on the ACA and co-authored the report, explained to NPR the impact of these changes on Americans.

“Costs went up significantly and a lot of people dropped their plans,” Cox said plainly.

“If you’re uninsured, you’re going to face higher costs if you need to go to the doctor,” she explained, with NPR noting that uninsured people were at risk of financial disaster if they experience a major illness or accident.

For those who have kept their ACA plans, nearly all of them have seen their healthcare costs increase. For example, the average ACA deductible — the out-of-pocket amount that customers must pay before their insurance kicks in — has gone up by an average of $1,000 per person, the largest single-year increase for the ACA since it was established.

Cox also explained that those people maintaining ACA insurance face a potential tradeoff.

“If you are paying a higher premium to keep your coverage again, you still might not have as much money to be able to afford to go to the doctor,” Cox said. “And if you move into a high-deductible plan, then that means that you might have to pay out a lot more money before your coverage kicks in.”

Republicans pushed cuts to ACA funding despite Democrats’ warnings of impact

Many policy experts and elected officials have been warning that this year would see rising costs and significant declines in healthcare coverage under the ACA.

The so-called One Big Beautiful Bill championed by President Trump and pushed through by congressional Republicans included significant cuts to funding for the Affordable Care Act, most notably by failing to renew subsidies that made ACA coverage more affordable for millions of Americans.

As the Republican-led Congress was poised to let ACA subsidies expire at the end of 2025, Democrats forced the longest-ever shutdown of the federal government in order to renew the ACA funding, though moderate Democrats ultimately cut a deal with Republicans to reopen the government without a firm commitment to restore the subsidies.

It is currently unclear whether the severe drop in ACA healthcare coverage will be a one-time decline or if more Americans will leave the healthcare market due to rising costs. Either way, it is now clear that millions of Americans are losing their healthcare, putting them in a risky position that could prove disastrous for those who end up facing significant injuries or accidents and are left to cover their medical bills on their own.