GEORGIA — Sign-ups for Affordable Care Act coverage in January 2026 came in about 1.2 million lower than the previous year's record enrollment, with approximately 23 million people enrolling in coverage for 2026. Average premiums for ACA enrollees rose 26% for the year, and enhanced premium tax credits that had been in place since 2021 expired at the end of 2025 after Congress did not extend them.

The One Big Beautiful Bill Act, passed last year, included provisions expected to reduce ACA enrollment and contributed to higher premiums in 2026. The Trump administration also ended a special enrollment program that had allowed low-income people to enroll in ACA coverage year-round. Premium tax credit amounts available under the law decreased or expired for 2026.

"In economic theory, no matter whether one is left, right, or center, it's a simple fact that when you raise prices of something, fewer people will buy it," said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. Insurers are likely to raise insurance rates again next year following larger-than-typical increases this year.

An average of 86% of ACA enrollees made their first premium payment in January 2026, according to a Wakely Consulting Group report. States operating their own ACA exchanges had a premium payment rate of 92%, while states served by the federal marketplace had rates of 82% to 84%. About 21% of people using the federal marketplace across 30 states failed to pay their share of January premiums, according to internal CMS data.

Payment failure rates varied by state, according to an analysis by Charles Gaba. Georgia saw a 28% drop in premium payments in April 2026 compared with the same period a year earlier. Washington state's payment failure rate was 15.7% as of February 2026, New Jersey's was 11.6% as of April 2026, and California's was 8.5% as of February 2026. New Mexico, which used state funds to fully backfill reduced federal subsidy amounts, saw an increase in the percentage of enrollees making premium payments year over year.

"We can't yet quantify how much worse it will be than in previous years, but it will absolutely be worse because of the sticker shock," said Ellen Montz, a managing director. The Wakely report said the individual market appears to be trending toward a contraction in 2026 and estimated that average ACA enrollment will be 17% to 26% lower than last year.

A KFF analysis released May 19 found that the average ACA plan deductible increased 37%, from $2,759 in 2025 to $3,786 in 2026. Bronze-plan sign-ups, which carry lower monthly premiums but higher deductibles, rose from 30% of total selections, or 7.3 million people in 2025, to 40%, or 9.2 million people in 2026.