10.29.2026 / Press Release

As Open Enrollment Starts, New Analysis Details the Demographics of the More Than Five Million Americans Who Dropped Marketplace Coverage After the Current Congress Decided to End Enhanced Tax Credits

WASHINGTON, D.C. – As Americans see new premium spikes while shopping for health coverage during 2027 open enrollment, which begins Sunday, a new Families USA analysis of Affordable Care Act (ACA) marketplace enrollment data details the coverage losses over the past year. The report breaks down the more than five million people who lost coverage in 2026 after Congress chose to let premium tax credit enhancements expire. Plan selections alone fell by 1.2 million compared to 2025, and 3.9 million enrollees fell off coverage after facing their first month’s premiums. Millions more dropped down to less comprehensive, higher deductible plans.

The report details that the people hit hardest were those who lost tax credit eligibility entirely, with enrollment drops of 34.7% for middle-income families earning more than 400% of the federal poverty level (about $64,000 for an individual in 2026) and 44.5% for low-income lawfully present immigrants under the poverty level. Other impacted groups include rural residents, young adults (18–34), and older adults (55–64), who faced particularly high premium shocks whether measured by percentage increase or as a share of income.

The analysis also describes how some states successfully stemmed coverage losses by backfilling parts of the lost tax credits, but these state solutions are short-lived. The report calls on Congress to permanently restore the premium tax credit enhancements to reduce enrollees’ premiums and help stabilize marketplace enrollment. Without federal action, it warns, continued premium increases and insurer exits will push affordable coverage further out of reach.

“Patients are paying the price for the current Congress’ choice to end enhanced premium tax credits,” said Anthony Wright, executive director of Families USA. “As a result, millions of Americans who buy coverage on the individual marketplace have seen their premiums double, are facing higher deductibles, or are dropping coverage altogether. They are living sicker, and one emergency away from financial ruin.”

While these premium increases and coverage losses are widely felt, the hardest-hit populations include older and rural residents facing particularly high premiums. Although undocumented immigrants are excluded from the marketplaces, these recent changes did cause many low-income lawfully present immigrants with incomes below the poverty level to lose coverage.

Some young people faced premiums that more than doubled, while middle-income families saw their premiums go from 8% of their income to a quarter or third. As Americans start to shop for 2027 coverage in open enrollment, they should remember that just last year those premiums were capped at a much lower percentage of their income.

During the 2026 open enrollment period, 23.1 million people selected a health plan, but nearly 4 million — 17% — did not pay their first month’s premium, so their coverage never took effect. In total, over 5 million fewer people had marketplace coverage than the previous year, either because they did not select a plan or did not activate it. The Trump administration claims this drop is a good thing and that many of those who lost coverage represent “phantom” enrollments. Families USA polling found that Americans aren’t buying it — more than half understand the drop is driven not by fraud but by the unaffordability of coverage.

For consumers who had relied on the enhanced premium tax credits, net premiums more than doubled, increasing by 114%, while gross premiums rose by 26%. As open enrollment begins, shoppers will see an average premium increase of 14.2% for 2027 coverage — the second straight year of significant spikes after more than five years of single-digit percent increases.

“After years of coverage highs, millions of Americans are being pushed and priced out of health coverage, or dropping down to less comprehensive, higher deductible plans,” Wright said. “After over five years of stability, shoppers for coverage are seeing a second year of double-digit percent increases, all due to the deliberate decisions of the current Congressional leadership. Congress can and should again cap the cost of coverage and take action to contain costs generally.”