When Republicans allowed the enhanced Affordable Care Act subsidies from the Inflation Reduction Act to expire last year, most people predicted that many Americans would drop their insurance coverage because they couldn’t afford premiums without those subsidies, and that the cost of coverage would go up for everyone. A new report from KFF, the nonprofit health care news and research organization, shows that at least some of that has already come to pass, and we’re not even halfway through the year. The worst may be yet to come.
Enrollment in the Obamacare marketplaces for 2026 fell by 1.5 million people, to 23 million—the first decrease since 2020. But that only counted people who chose to drop their insurance during the open enrollment period. An analysis by the Wakely Consulting Group found that only 86 percent of enrollees had paid their January premiums by their due dates, putting them at risk of losing their insurance. Monthly premiums are on average 58 percent higher this year, which means more families will continue to struggle to pay and even more people may lose their coverage as the year goes on. Wakely estimates that marketplace coverage overall could drop by almost six million people this year compared to last year.
But that’s only part of the problem. Facing the full cost of higher premiums, many people shifted to high-deductible “bronze” plans this year: KFF found that the average deductible across all plans—bronze, silver, and gold—rose 37 percent to a record high of nearly $3,800. “This is the steepest increase in deductibles ever seen in this market and largely reflects the shift from silver plans with reduced deductibles for lower-income enrollees to bronze plans with very high deductibles,” the report states.
Those who did so took a gamble. The average cost of bronze plans varies by state, but the premiums still cost an average of $456 a month nationwide. Those plans provide preventative care for free, like all ACA plans do, but if the people relying on them get sick, have an accident, or need treatment from a specialist for any other reason—like physical therapy, body scans, or surgery—they will have to meet their deductibles before their coverage kicks in. The KFF report shows that the average deductible for bronze plans is $7,476.
For people who are unlikely to get sick, or who have enough disposable income to take advantage of the tax-advantaged health savings accounts that are available this year, the bronze plans can save money. But it’s likely that many people who opted for bronze plans this year were just trying to find the lowest premiums possible because they couldn’t afford anything else. That means they have health insurance that they can’t really use because they can’t afford to.
Those who can’t afford their deductibles are more likely to wait longer to seek the healthcare they need, or go without it entirely, and often have worse outcomes. High-deductible plans are also likely to leave more Americans in debt if something does happen and they are swamped with bills they can’t pay. Many Americans who have chosen bronze plans are simply crossing their fingers that nothing bad happens, which isn’t providing the peace of mind that insurance is supposed to bring.
The bad news for all of us is that these are the kinds of plans Republicans want to force us all into, based on the false idea that the tight-budgeted “consumers” will be compelled to shop for the lowest-priced care and that this will drive down health care costs overall. But receiving worse care and facing unpaid medical debt will just move us closer to where we were before the ACA was enacted, when more Americans were uninsured or underinsured and facing mountains of medical debt. The U.S. is already teetering on the edge of a debt crisis, and piling more medical debt onto struggling Americans could be one of the things that pushes us over the cliff.
