Approximately one in seven Americans who signed up for Affordable Care Act (ACA) health insurance plans this year failed to pay their initial premiums as costs rose sharply following the expiration of federal subsidies, according to a report by The Wall Street Journal.
An analysis by Wakely Consulting Group, provided exclusively to the Journal, found that roughly 14% of national enrollees did not pay their first monthly bill for January coverage. In some states, that figure reached 25% or higher.
The drop-off comes as expanded federal subsidies—introduced during the pandemic to lower consumer costs—lapsed at the start of January. This expiration coincided with major rate hikes implemented by insurers to combat rising healthcare costs.
“It’s a big drop,” Michelle Anderson, a Wakely consulting actuary, told the Journal.
Overall ACA sign-ups had already shown signs of cooling, falling to 23 million in 2026 from a peak of more than 24 million the year prior. Based on the high rate of nonpayment, Wakely actuaries project that total enrollment for 2026 could ultimately sink by 17% to 26% compared to last year.
The data, which represents approximately 80% of national ACA enrollment across 30 states, highlights significant regional disparities. States utilizing the federal HealthCare.gov marketplace saw higher average nonpayment rates than those with their own exchanges.
In one extreme case, Blue Cross Blue Shield of Arizona reported losing more than 30% of its initial 2026 members by the end of March, primarily due to nonpayment. “It is simply because the cost of health insurance is more than what they can afford,” said CEO Pam Kehaly, noting the insurer lost only 2% of members for nonpayment the previous year.
The trend poses a long-term risk to market stability. Health experts noted that younger, healthier enrollees are the most likely to drop coverage when prices rise, leaving a greater proportion of sicker, costlier patients in the insurance pool. Data showed that those who successfully made their January payments were about 10% less healthy than those who defaulted.
This shift may force insurers to implement further premium increases next year to cover the higher average costs per enrollee.
For many, the price increases made coverage untenable. Sarah Smith, a 53-year-old office manager in Ohio, dropped her plan after the monthly cost for her and her son jumped from $150 to $700. Smith opted for a cheaper, short-term plan that does not cover pre-existing conditions.
Similarly, Sharon Dunham, 63, a two-time cancer survivor, chose to go uninsured after her monthly premium rose to $980 following the loss of her subsidy. “It is definitely terrifying,” Dunham said of the prospect of her cancer recurring while she awaits Medicare eligibility at age 65.
The issue is expected to become a major political flashpoint heading into this year’s midterm elections, as voters continue to cite healthcare costs as a primary source of financial strain.