One in seven Americans who signed up for Affordable Care Act (ACA) health plans this year did not pay their first monthly premium, as the lapse of enhanced federal subsidies drove insurance costs sharply higher, according to a report published Tuesday.
The Wall Street Journal, citing an exclusive analysis from actuarial firm Wakely Consulting Group, reported that approximately 14% of ACA enrollees nationwide failed to pay their January premiums. In some states, the nonpayment rate reached 25% or more.
Wakely’s data was drawn from insurers representing roughly 80% of national ACA enrollment across 30 states. Michelle Anderson, a Wakely consulting actuary, called it “a big drop,” noting that early-year falloff in ACA membership typically runs in the mid-single-digit range.
A Market Under Pressure
ACA enrollment had already declined to 23 million sign-ups in 2026, down from a peak of more than 24 million the prior year. The expiration of pandemic-era subsidies at the start of January forced many policyholders to absorb steep premium increases simultaneously with major insurer rate hikes tied to rising healthcare costs.
Wakely actuaries projected overall ACA enrollment could fall between 17% and 26% compared with last year. Blue Cross Blue Shield of Arizona disclosed it lost more than 30% of members who initially enrolled in 2026 plans, nearly all due to nonpayment, compared with just 2% the prior year.
Political Fallout And Broader Strain
The coverage losses have deepened public anxiety about healthcare affordability. A Gallup poll released in April found that 61% of Americans worry “a great deal” about access to and the affordability of healthcare, reclaiming the top spot among domestic concerns.
The political response has been sharp on both sides. Senator Mark Kelly (D-Ariz.) criticized the Trump administration and Republican lawmakers for allowing premiums to rise to unaffordable levels. President Trump, separately, has called the ACA the “Unaffordable Care Act” and proposed routing federal support directly to consumers rather than insurers.
Disclaimer: This content was produced with the help of AI tools and was reviewed and published by Benzinga editors.
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