A dramatic decline in health insurance participation is expected nationwide this year, with nearly 5 million Americans potentially losing their coverage as healthcare costs continue to climb, according to fresh research from the healthcare research nonprofit KFF.
The study reveals that individuals who maintain their insurance plans are facing significantly higher expenses, with typical deductibles jumping more than $1,000 and monthly premium costs increasing by $65 on average.
“No matter how you slice it, people are paying more,” said Cynthia Cox, a vice president of KFF who co-authored the report.
This dramatic decrease in participation, which exceeds what early government statistics indicated, demonstrates how escalating healthcare expenses are compelling Americans to make difficult mid-year choices about maintaining their health insurance. The cost increases stem partly from the January 1st end of financial assistance that had previously helped most participants afford their plans.
The findings could significantly influence upcoming midterm elections, as economic pressures remain a primary concern for voters in competitive districts nationwide.
According to KFF’s analysis, which incorporated government data from federal and state sources plus research from the actuarial firm Wakely Consulting Group, participation in the program may decrease from 22.3 million Americans in 2025 to approximately 17.5 million this year.
This represents a substantial reduction for the government’s primary subsidized health insurance option targeting working-age Americans who don’t meet Medicaid requirements. The program has gained popularity recently among gig workers, farmers, ranchers, hairstylists and other professionals who don’t receive employer-provided health benefits.
Cox explained that a major factor behind this steep decline involves automatic renewals from previous year plans. Many of these plans now carry much higher price tags due to expired financial assistance and additional market pressures.
Cox noted that when individuals can no longer afford the monthly payments during the year, they forfeit their coverage.
The research found that middle-income Americans discontinued their coverage at higher rates compared to other income brackets. This demographic earns too much to qualify for remaining program subsidies designated for lower-income participants, yet insufficient income to easily afford coverage without the pandemic-era enhanced subsidies that have now ended.
KFF discovered decreases in program participation across most states, though states operating their own exchanges maintained higher enrollment percentages than those using the federal marketplace.
The current administration attributes most of this year’s enrollment decline to federal initiatives aimed at eliminating program fraud. The Centers for Medicare and Medicaid Services, whose complete 2026 enrollment figures remain unpublished, did not immediately provide comments regarding KFF’s findings.
Last year, anticipating the conclusion of pandemic-era subsidies that had increased enrollment and reduced costs for program users over four years, KFF had predicted that premium payments would more than double in 2026.
However, the latest analysis shows premium payments increased by a more moderate 58% on average. This occurred partly because many participants switched to lower-premium, higher-deductible plans that will only cost them additional money if they actually use their coverage, according to KFF’s report.
“People are trying to hang on to their health insurance coverage any way they can, even if that means they have a deductible of $7,000,” Cox said.
She added that the potentially positive development is that insurance companies appear to have anticipated and already adjusted for many of the marketplace changes currently occurring.
This could indicate that future healthcare costs may not need to increase as dramatically.
“I’m hopeful that this could be a one-time market correction and that we might not need to see such a high premium spike in the coming year,” Cox said.
