In what analysts describe as a “deep retrenchment” for the landmark healthcare program, sparked by the expiration of enhanced federal subsidies that had previously shielded consumers from the full weight of rising premiums.
Preliminary data and industry reports indicate that enrollment has plummeted since Congress allowed pandemic-era tax credits to lapse at the end of 2025, according to the New York Times.
While initial sign-ups were already down by approximately 1.2 million, insurance companies and state officials now estimate that the total decline could reach a total of 5 million fewer patients, a 20 percent drop, with enrollment falling from 24 million last year to roughly 19 million.
Some projections from the Wakely Consulting Group suggest even steeper losses of up to 26 percent as the full impact of higher costs hits household budgets.
The exodus is largely attributed to a “subsidy cliff” created when the Republican-controlled Congress hit a stalemate over extending financial assistance authorized in 2021. These subsidies had rendered insurance free for many low-income enrollees and provided critical support for middle-class families earning above $63,000 annually.
Without this federal backing, many Americans are facing monthly premiums that have doubled or even tripled. In Georgia, where enrollment had tripled since 2021, state data shows coverage has already fallen by more than one-third.
“I can’t afford a second mortgage every month,” said Megan Burkett, a nurse practitioner in California who saw her family’s monthly premium jump from $307 to $2,500—a figure nearly identical to her mortgage payment.
Similarly, Joyce Rena Bumbray-Graves, a 63-year-old home care worker, told the New York Times her premiums more than doubled to over $1,300, forcing her to drop coverage entirely.
The cost spikes are particularly severe for early retirees and middle-class earners, with some groups seeing increases of $1,000 a month or more depending on their age and location. Even those who remain insured are increasingly opting for “leaner” coverage; approximately 10 percent of enrollees have switched to bronze plans, which carry lower premiums but feature deductibles as high as $10,600.
CIGNA EXIT SIGNALS DEEPENING MARKET FRAGILITY
The instability of the individual marketplace has begun to drive out major insurers, further threatening the long-term viability of the ACA. Cigna Group announced it will exit the ACA individual insurance market after 2026, a move that will force approximately 369,000 members across 11 states—including Texas, Florida, and Virginia—to seek new coverage for 2027.
Cigna’s departure follows a similar retreat by CVS Health’s Aetna, which pulled out of the 2026 market, impacting roughly 1 million members. Cigna President and COO Brian Evanko stated there was no “clear path to scale this business” within the company’s current portfolio, signaling a shift in focus toward employer-sponsored insurance and pharmacy benefit management.
Industry experts warn that these exits could trigger a “death spiral” in the remaining markets. Wakely Consulting Group flagged that healthier enrollees are the most likely to drop coverage as costs rise, leaving a sicker, higher-risk pool for the remaining insurers. This imbalance makes setting sustainable prices for 2027 and beyond increasingly difficult.
The Biden-era expansion of the ACA is now a central flashpoint ahead of this year’s midterm elections. Democratic lawmakers made the extension of subsidies a central demand during a record 43-day government shutdown earlier this year, but were unable to break the Republican opposition.
The administration has sought to downplay the severity of the enrollment drops. Chris Krepich, director of communications for the Centers for Medicare and Medicaid Services (CMS), characterized the marketplace as “strong and resilient,” despite the reported losses. Health Secretary Robert F. Kennedy, Jr. attributed the initial reductions to a “crackdown on fraud” rather than a lack of affordability, noting that 87 percent of enrollees still owed less than $96 a month as of January.
However, insurers are already seeing the impact on their bottom lines. Centene, a major player in the marketplace, reported having two million fewer customers at the end of March compared to the previous year—a drop of more than one-third. UnitedHealth also reported significant declines.
As the 90-day grace period for premium payments ends in most states, analysts expect the full scale of the enrollment collapse to become even clearer by mid-year.
“I think we haven’t seen the full impact of all of these changes,” Hemi Tewarson, executive director of the National Academy for State Health Policy told the New York Times.
With major carriers like Cigna and Aetna heading for the exits, the future of the ACA as a reliable source of private insurance for millions of Americans remains in significant doubt.
Health sharing ministries (HSMs) offer several compelling advantages for healthy individuals who’ve opted out of ACA (Obamacare) coverage.
The most obvious benefit is that the cost tends to drop significantly but many who switch to health sharing cite a greater flexibility and individual choice as another plus.
HSM’s are particularly attractive to healthy people with predictable, low medical usage and appeal to people who appreciate belonging to a community of like-minded people rather than a faceless corporation.
It should be remembered that HSM’s are not insurance and are not regulated as such.