In this archived photograph from Aug. 19, 2025, pages from the healthcare.gov website, which pertains to U.S. Affordable Care Act health coverage, are visible on a computer display in New York.Patrick Sison/AP, FILE
Over 10% of individuals enrolled in the Affordable Care Act did not remit their health insurance payments at the start of the year, as per a report by the actuarial company Wakely Consulting Group.
The firm analyzed enrollment and premium information from participating providers in 2025 and January 2026. This information encompassed roughly 80% of the entire individual market, meaning health coverage obtained directly by individuals or families rather than through an employer or a governmental initiative.
The report indicated that 14% of those enrolled failed to make their initial payment in January.
Because enrollees are failing to pay their premiums, public health authorities are concerned that these individuals might experience a policy lapse and become uninsured. This could prevent them from obtaining routine or preventative medical care, potentially leading to more visits to the emergency department, which could intensify the strain and financial burden on an already overwhelmed system.
The data also revealed substantial “buy downs,” where enrollees transitioned to less costly or lower-tier plans. Enrollment in Bronze plans increased by 11%, while enrollment in Silver plans decreased by 17%.
In states where Gold plan premiums were cheaper than Silver plans, enrollment in Gold plans rose by 6%.
In this archived photograph from Aug. 19, 2025, pages from the healthcare.gov website, which pertains to U.S. Affordable Care Act health coverage, are visible on a computer display in New York.Patrick Sison/AP, FILE
The report is released amidst escalating expenses and the termination of the enhanced premium tax credits.
The premium tax credits, also referred to as ACA subsidies, aid in reducing or eliminating the out-of-pocket expense of recurring premiums for those who secure coverage via the health insurance marketplace.
Eligibility for the subsidies can be ascertained based on factors such as household earnings and geographical location.
The subsidies were integrated into the original ACA that was approved during the Obama administration. The level of monetary aid was augmented, along with eligibility, throughout the COVID-19 pandemic.
The majority of individuals registered in the ACA marketplace were obtaining augmented premium tax credits to lessen their recurring premiums, and numerous were anticipating an increase in their premiums in 2026.
In October and November, the subsidies evolved into a contentious issue during the most protracted government shutdown in U.S. history.
Republicans contended that the expansions from the pandemic era had gone too far and attempted to induce Democrats to finance a temporary spending measure that did not address the expiring ACA subsidies, while promising to deliberate on methods to prolong the subsidies at a later time.
Conversely, Democrats insisted on prolonging the premium tax credits as a component of a measure to conclude the shutdown, cautioning that their expiration could be damaging for millions of American families.
In early November, the Senate achieved a bipartisan agreement to put an end to the shutdown — which did not encompass any of the Democratic requests pertaining to health care. Eight Democrats sided with Republicans, and the measure was subsequently approved by the House as well.
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Sources conveyed to ABC News that Republican leadership pledged to permit a vote on a measure selected by Democrats concerning the ACA in December, but a set of competing health care-related measures failed to progress in the Senate earlier in the month.
In January, the House sanctioned a Democratic-sponsored measure that would witness the enhanced premium tax credits extended for three years. The measure has been stalled in the Senate.
Assessments from the Congressional Budget Office have implied that gross benchmark premiums — the cost of a standard plan before governmental subsidies are utilized — could surge by 4.3% in 2026 and by 7.7% in 2027 without an extension.
Sourse: abcnews.go.com