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ACA Enrollees Skip Premiums, Risking Coverage Lapse
16 Apr
Summary
- More than 1 in 10 ACA enrollees missed their initial premium payment.
- A significant number of enrollees are downgrading to cheaper plans.
- Expiration of enhanced ACA subsidies is contributing to rising costs.
As of early 2026, a significant portion of Affordable Care Act (ACA) enrollees, exceeding one in ten, have not paid their initial health insurance premiums. This raises concerns about policy lapses and individuals becoming uninsured, which could lead to increased reliance on emergency care and greater financial burdens. The data, representing about 80% of the individual market, indicates a trend of enrollees downgrading to less expensive plans, with Bronze plan enrollment up 11% and Silver plan enrollment down 17%.
This situation is exacerbated by rising health insurance costs and the impending expiration of enhanced premium tax credits, also known as ACA subsidies. These subsidies, originally part of the ACA, were expanded during the COVID-19 pandemic to lower out-of-pocket premium costs. Without their extension, benchmark premiums are projected to increase substantially in 2026 and 2027. Political debates surrounding these subsidies have impacted legislative efforts to extend them, with a Democratic-led bill to extend the enhanced credits for three years currently stalled in the Senate.
