ACA Enrollment Projected to Fall 17 to 26 Percent in 2026

The Wakely Consulting Group reported that enrollment in Affordable Care Act individual market plans is projected to decline between 17 and 26 percent for 2026. The estimate is based on data covering 80 percent of the market. Congress declined to extend subsidies that had been in place under the ACA beginning in January.

Wakely stated that price increases between 25 and 115 percent led more than one million people to drop coverage, with additional departures expected through the end of the year.

Individuals are shifting to plans with higher deductibles and fewer benefits or opting out of coverage entirely. Without an individual mandate, people are paying cash for services or using alternatives such as crowd-health arrangements. Those remaining in ACA plans are described as less healthy on average, which Wakely said increases pressure on premiums and risk-pool calculations.

Cash-paying patients sometimes receive discounts of 50 to 80 percent compared with insured rates, according to the report. Direct primary care services charging around $100 per month are also gaining users. Wakely noted that the changes are occurring gradually across states and age groups, making aggregate effects difficult to measure.

The firm projects continued enrollment reductions absent new legislation.