More Americans skipping Obamacare premium payments amid rising costs
An uptick in people skipping Obamacare premium payments in many states suggests the Affordable Care Act's rising costs are hitting home for 2026 enrollees.
Objective Facts
An uptick in people skipping Obamacare premium payments in many states suggests the Affordable Care Act's rising costs are hitting home for 2026 enrollees. A KFF analysis released May 19 found that the average ACA plan deductible saw the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired. Wakely Consulting Group estimates that average ACA enrollment will end up being 17% to 26% lower this year than last, based on data from 75 insurers. Payment failure rates varied by state, including 11.6% as of April in New Jersey, 15.7% in Washington state as of February, and 8.5% in California. States with the lowest drop-off rates had enacted additional help such as backfilling part or all of the reduced subsidy amounts with state money or experienced lower premium increases.
Left-Leaning Perspective
Economic analyst Steve Rattner, appearing on MSNBC's Morning Joe, analyzed data showing how millions of Americans have dropped ACA coverage due to rising costs, attributing this directly to Republicans' failure to extend enhanced subsidies. Rattner demonstrated specific impacts: a 60-year-old making $65,000 a year now stands to pay $920 more per month, equaling $11,040 a year in additional costs, and stated "if you're making $65,000, paying $11,040 a year for health insurance is simply not realistic." The Democratic Congressional Campaign Committee launched political attacks on Republican representatives, citing data showing premiums have risen 58% on average, and targeting Colorado GOP Reps. Jeff Crank and Gabe Evans for their votes to cut Medicaid and refuse to extend ACA subsidies. Democratic Senator Peter Welch stated "There's a number of Republican and Democratic senators who are seeing what a disaster this will be for families that they represent," suggesting there is common ground on extending the credits and "it's a doable thing."
Right-Leaning Perspective
Paragon Health Institute, a free-market think tank influential among conservatives on Capitol Hill, argued through its president Brian Blase that record enrollment numbers in recent years were fueled by fraudulent sign-ups in the millions, predicting about 19 million people would be enrolled by year's end based on historical premium payment failure rates. House Judiciary Chair Jim Jordan issued subpoenas to eight health insurers—Elevance, CVS, Centene, GuideWell, Oscar Health, Kaiser Permanente, Health Care Service Corporation and Blue Shield of California—seeking information on subsidized ACA enrollees and fraud discussions. The Trump administration claimed wins in reducing ACA fraud while proposing a sweeping set of new regulations for next year, including stepped-up requirements for applicants to prove eligibility for subsidies and new scrutiny of sales agents. President Trump and aligned GOP leaders promoted sending money directly to consumers through flexible accounts rather than continuing ACA tax credits, reflecting a broader preference for consumer-driven healthcare solutions.
Deep Dive
The core issue driving this story is the expiration of enhanced ACA premium subsidies enacted during the COVID-19 pandemic. These subsidies were first given to Affordable Care Act enrollees in 2021 as a temporary pandemic measure, which Democrats in power extended, moving the expiration date to the start of 2026. Republican lawmakers passed the One Big Beautiful Bill Act last year, which included provisions expected to reduce ACA enrollment and was cited among factors fueling higher premiums in 2026. The result is a market shock: Nationwide ACA enrollment could plummet by nearly 5 million people this year, with those who remain covered paying more for healthcare, including average deductibles growing by more than $1,000 and average monthly premium payments rising by $65. Both sides identify legitimate issues but emphasize different drivers. Democrats focus on affordability crisis forcing families to choose between coverage and other necessities, while Republicans highlight the need to address program integrity issues and question whether subsidies created demand for fraudulent enrollments. However, insurers, hospitals, and policy experts have taken issue with Paragon's fraud estimates, saying they were likely vastly overestimated. The data suggests both factors may contribute: Payment failure rates varied significantly by state (11.6% in New Jersey, 15.7% in Washington, 8.5% in California), suggesting cost sensitivity varies by geography. The unresolved question is whether the projected 21.5% enrollment decline from 22.3 million to 17.5 million represents people priced out of the market or correction of inflated enrollment figures. What to watch: whether Congress acts before the midterm elections to extend subsidies; whether additional Trump administration fraud controls succeed in improving program integrity without blocking eligible Americans; and whether the coverage losses translate into political consequences for Republicans in competitive races.