What’s Happening

Millions of Americans are leaving Affordable Care Act, or Obamacare, health plans as higher premiums and deductibles make coverage harder to afford.

About 3 million people dropped out of the ACA marketplace in 2026 after costs increased sharply. The ACA marketplace had covered about 19.2 million people as of February.

Some people who left their plans are moving to cheaper short-term insurance, joining health-sharing programs, or going without insurance altogether.

The change is creating concerns about whether people will have enough protection when they need medical care.

Why Are People Leaving Obamacare Plans?

One major reason is the expiration of enhanced federal premium tax credits that had helped make ACA coverage more affordable.

Without those additional subsidies, some people saw their monthly premiums increase significantly.

Higher deductibles are another problem. A deductible is the amount a person must generally pay for covered healthcare services before their insurance begins paying according to the plan's benefits.

For people with high deductibles, having insurance does not necessarily mean that routine medical care is affordable.

Some consumers interviewed for the report said their premiums doubled or increased substantially.

What Are People Choosing Instead?

People who left ACA plans are taking several different approaches.

Short-Term Health Plans

Some consumers are choosing short-term insurance because it can cost considerably less than an ACA plan.

One Maryland business owner said his ACA premium was expected to rise to more than $1,000 per month. He instead chose a short-term plan costing about $600 per month.

The plan provides coverage for major expenses such as hospitalization and critical illnesses.

However, short-term plans generally provide less comprehensive coverage than ACA plans and can have different rules and limitations.

Under current federal rules, short-term plans are generally limited to three months plus a one-month renewal, although some states allow longer coverage.

Health-Sharing Programs

Others are joining health-sharing programs.

These programs generally involve members making monthly contributions into a pool that helps pay eligible medical expenses for other members.

They are different from traditional health insurance and generally do not provide the same consumer protections.

One woman interviewed said she pays about $480 per month for herself and her young adult children through a health-sharing program.

Her program includes certain preventive services, but members must first pay $5,000 in eligible expenses before additional costs can be submitted to the sharing program.

Going Without Insurance

Some people are choosing not to have coverage at all.

This can create significant financial risk if someone develops a serious illness or needs emergency treatment.

Hospitals have also reported higher costs associated with treating uninsured patients.

People Are Skipping Medical Care

The affordability problem is not limited to insurance enrollment.

Several people interviewed said they had delayed or skipped preventive care, annual checkups, screenings, and other treatment because of high healthcare costs.

One woman who is at elevated risk for breast cancer said she had skipped regular cancer screenings because she could not afford them.

Others said they were choosing to pay out of pocket for urgent care when necessary rather than maintaining expensive insurance coverage.

This creates a potential public-health concern because delaying preventive care can mean that some conditions are detected later, when treatment may be more complicated or expensive.

What’s Changing / Business Impact

The shift away from ACA coverage could affect several parts of the U.S. healthcare system.

Hospitals and health systems may see more patients who are uninsured or have less comprehensive coverage.

Patients may also become more sensitive to healthcare prices and may increasingly compare self-pay rates, insurance benefits, deductibles, and out-of-pocket costs before seeking care.

Insurers could also face changes in their customer mix as consumers move between ACA plans, short-term products, employer coverage, and other arrangements.

For 2027, insurers have proposed a median ACA marketplace premium increase of about 15%, marking another year of double-digit proposed increases.

ACA enrollment for 2027 is scheduled to run from November 1 through January 15.

Why This Matters

The ACA was designed in part to make health insurance more accessible to people who do not receive coverage through an employer.

As costs rise, some consumers are instead choosing products that may offer lower monthly payments but provide fewer benefits or protections.

Health-sharing programs are one example.

Experts have warned that these programs and other nontraditional coverage products can have significant limitations. They have also raised concerns about aggressive or misleading marketing in parts of this market.

This means consumers may need to look beyond the monthly price and understand exactly what a plan covers, what it excludes, and how much they could have to pay themselves.

Looking Ahead

The affordability problem is likely to remain important as insurers prepare their 2027 ACA offerings.

The next major enrollment period begins November 1.

For consumers, the decision will involve comparing monthly premiums with deductibles, provider networks, covered services, and potential out-of-pocket costs.

For healthcare providers, insurers, and policymakers, another important issue will be whether more people remain uninsured or move into less comprehensive coverage.

A continued shift away from comprehensive insurance could affect how patients access preventive care and how hospitals manage uncompensated care.

What This Means for Healthcare Marketers

The changing insurance market creates several important signals for healthcare marketers:

  • Insurance churn: People moving between ACA plans, short-term coverage, employer plans, and uninsured status can change the addressable patient population for healthcare organizations.
  • Affordability messaging: Providers and healthcare companies may need clearer communication around costs, payment options, and covered services.
  • Patient engagement: Patients facing higher costs may need more information before deciding whether to schedule preventive care or treatment.
  • Market access: Changes in insurance coverage can affect which patients can access specific providers, treatments, and services.
  • Consumer behavior data: Changes in enrollment and coverage can help organizations understand where patients may be delaying or avoiding care.
  • Provider strategy: Health systems could see changes in payer mix as more patients move into short-term plans or become uninsured.
  • Insurance market signals: Premium increases, enrollment changes, new plan offerings, and shifts in payer participation can indicate changing market opportunities.

For B2B healthcare marketers, changes in insurance coverage are also changes in the healthcare buyer and patient landscape. Tracking payer enrollment, plan changes, affordability pressures, and coverage shifts can help organizations anticipate changes in patient demand and market needs.

Key Takeaways

  • About 3 million Americans left ACA marketplace coverage in 2026 as premiums and deductibles increased.
  • The ACA marketplace covered about 19.2 million people as of February.
  • Some people are moving to short-term insurance, while others are joining health-sharing programs or going uninsured.
  • Short-term plans can be cheaper but generally provide less comprehensive coverage.
  • Some consumers are delaying preventive care and treatment because of higher healthcare costs.
  • Hospitals are reporting increased costs associated with treating uninsured patients.
  • Insurers have proposed a median 15% increase in ACA premiums for 2027.
  • The changing insurance landscape could affect patients, providers, insurers, and healthcare businesses across the U.S.