As 2025 draws to a close, early enrollment figures for the Affordable Care Act marketplace have sparked concern among health officials, policy experts, and consumer advocates. With key pandemic-era subsidies set to expire at the end of December, the U.S. Centers for Medicare and Medicaid Services reported a noticeable drop in sign-ups for health insurance plans covering the 2026 calendar year. The numbers mark a reversal from recent years when enhanced federal financial assistance had driven record enrollment across the country.
The subsidies in question were introduced during the COVID-19 pandemic as part of sweeping legislation intended to protect public health and expand access to care. They significantly reduced monthly premiums for millions of Americans purchasing insurance through ACA marketplaces. Those enhanced tax credits were extended through subsequent bills, enabling families and individuals—particularly those in lower- and middle-income brackets—to afford coverage that had previously been out of reach. But with no new congressional action to maintain them, these subsidies are now scheduled to lapse on December 31.
The financial implications for consumers are substantial. Without these federal subsidies, many individuals will face steep increases in their monthly premium payments. For some enrollees, the difference could mean hundreds of dollars more per month. As a result, many consumers who previously found ACA plans affordable are now re-evaluating their options or considering going without insurance entirely. This drop in affordability is being cited as one of the primary reasons for the slower pace of enrollments for the 2026 plan year.
Health policy researchers have long warned that premium hikes and reduced subsidies could trigger a cascade of negative consequences. The most immediate concern is that people will forgo health insurance altogether, either because they believe they can’t afford it or because they don’t perceive immediate need. Historically, uninsured individuals are more likely to delay preventive care and less likely to seek timely treatment, often leading to worse health outcomes and higher long-term medical costs. The drop in enrollment also threatens to destabilize insurance markets, particularly if healthier individuals opt out and risk pools become more concentrated with higher-cost enrollees.
Advocates for expanded health care access are especially concerned about the impact on lower-income populations. Many of these households depend on ACA plans for access to doctors, prescriptions, and routine care. With premiums on the rise, some may turn to alternative options like high-deductible plans that offer limited coverage or seek care only in emergencies. Others may fall into what’s known as the “coverage gap,” particularly in states that have not expanded Medicaid, leaving them with few affordable or effective options for maintaining health coverage.
While the federal open enrollment period remains active through mid-January, the current decline in early sign-ups has prompted calls for urgent outreach. State exchanges and nonprofit organizations have launched information campaigns to encourage consumers to enroll before the deadline, emphasizing that financial assistance may still be available depending on income and location. In many cases, navigators and insurance brokers are working overtime to help individuals assess their eligibility, compare plans, and make informed decisions during a period of heightened uncertainty.
Despite the challenges, there is cautious optimism that a late surge in enrollment could offset some of the initial shortfall. In previous years, ACA sign-ups have often spiked in the final weeks before the deadline, as consumers become more aware of the enrollment window or respond to last-minute reminders. However, advocates acknowledge that the expiration of subsidies has made this year’s landscape far more complex. Many would-be enrollees are expressing frustration and confusion as they discover that plans they relied on in 2025 are no longer within reach in 2026.
The political ramifications of the subsidy lapse are also beginning to emerge. Members of Congress who supported extending the enhanced subsidies argue that their expiration could erase hard-fought gains in reducing the uninsured rate. Proposals to reinstate or redesign federal financial assistance have been introduced but face uncertain prospects in a divided legislative environment. In the meantime, several states are exploring stopgap measures of their own, including the use of state funds to extend subsidies or expand Medicaid eligibility criteria. But these efforts are patchwork solutions, and without a federal fix, disparities between states are expected to grow.
Industry observers note that the ACA marketplace had, until this point, seen unprecedented growth thanks to the combination of federal support, improved enrollment infrastructure, and heightened awareness of health care during the pandemic. With the withdrawal of subsidy support, that momentum may stall. Health insurers are now watching enrollment trends closely as they prepare for shifts in the risk pool that could influence premiums and plan offerings in future years.
As the January enrollment deadline approaches, many Americans face a difficult choice: pay more for coverage, accept plans with limited benefits, or risk going uninsured in a volatile health care landscape. For those living paycheck to paycheck, the end of enhanced subsidies could mean the difference between maintaining essential care and making painful trade-offs.
The Affordable Care Act remains a cornerstone of the U.S. health care system, but the latest developments highlight the fragile balance between public policy and consumer access. The next several weeks will serve as a critical test of how the country navigates this turning point—and whether enough action is taken to preserve the health security of millions now at risk.
