People are using this tactic to afford rising ACA insurance bills

The expiration of the Affordable Care Act's enhanced subsidies left millions of Americans who wanted to keep their insurance in 2026 with a costly choice. Stick with their mid-tier silver plan and pay a pricier monthly bill or downgrade to cheaper coverage.

An analysis released May 19 suggests many switched to plans with cheaper monthly premiums but will pay higher deductibles − the amount a person must pay before most insurance coverage kicks in.

Average deductibles for ACA plans reached $3,786 in 2026, up more than $1,000 from a year ago, according to KFF, a health policy nonprofit.

Nearly 4 million Americans dropped their mid-tier silver plans, with a total of 9.8 million enrollees, according to KFF. Meanwhile, sign-ups for lower-tier bronze plans reached 9.2 million, a jump of nearly 2 million from a year ago.

How many Americans will drop their ACA coverage?

It's still unknown how many Americans have already or plan to drop ACA coverage, often called Obamacare.

The Centers for Medicare & Medicaid Services on Jan. 28 reported about 23 million Americans signed up for ACA coverage in 2026, down from 24.2 million signups as of January 2025.

But those figures include many who were automatically reenrolled. If those consumers fail to pay monthly premiums that KFF said increased an average of 58% in 2026 without the enhanced subsidies, their coverage will eventually be terminated. CMS won't report those figures until later this year.

About 86% of enrollees paid their monthly premiums in January, according to Wakely Consulting Group. The consultant, which analyzed data from insurers in more than 30 states, estimated ACA enrollment this year would drop 17% to 26% from a year ago.

KFF projected nearly 5 million could drop their ACA coverage this year. KFF's analysis was based on Wakely's estimates and federal data.

The coverage losses "look like what people expected," said Cynthia Cox, vice president and director of the program on the ACA at KFF. "Which is millions of people might drop ACA coverage with the lack of enhanced premium tax credits."

Some ACA critics, however, say another factor might account for enrollment drops. The conservative think tank Paragon Institute said the COVID-19-era enhanced premium subsidies and lax oversight helped fuel potentially millions of fraudulent signups.

Beyond ACA coverage, Americans are broadly worried about the cost of health care as they struggle to pay for other living expenses, such as rising gas bills and housing costs.

In April, a Gallup poll reported that 6 in 10 Americans worry they will not be able to cover medical costs if they suffer a serious accident or illness. Nearly half are concerned about routine costs.

Couple cuts out restaurants, vacations to pay for Obamacare

Some are struggling to pay for ACA insurance coverage due to significantly higher monthly bills.

In 2025, Wisconsin resident Kelly Berry and her husband had individual bronze insurance plans that had a $7,500 deductible but were fully subsidized. This year, they pay a combined $2,300 per month for plans that carry $8,000 deductibles.

Berry and her husband are self-employed and earn slightly too much to qualify for ACA subsidies that remain in place for people who earn up to four times the federal poverty level.

Berry said she kept the bronze-level plan "because I can’t find anything cheaper and won’t go without coverage."

But she said it's a struggle. They've skipped on landscaping expenses, such as removing dead bushes and trees from the yard. They have no vacation plans other than visiting with aging parents. They avoid dining out and scrutinize every grocery bill.

"There’s no easy way to find an extra $2,300 by cutting expenses," Berry said. "Every time we pay a bill − the mortgage, a credit card, the health insurance premium − we have to watch our bank accounts to make sure we have money in the right places to cover things."