14% of ACA enrollees did not pay premiums in January: Report
More than one in 10 Affordable Care Act enrollees did not pay their health insurance premiums at the beginning of the year, according to a report from the actuarial firm Wakely Consulting Group.
The firm looked at enrollment and premium data from participating issuers in 2025 and January 2026. The data represented an estimated 80% of the total individual market, or health insurance purchased directly by individuals or families rather than through an employer or government program.
The report found that 14% of members did not pay their first premium in January.
By enrollees not paying their premiums, public health officials fear these people could have a policy lapse and become uninsured. This could cut them off from receiving preventive or routine health care and require more emergency room visits that will add more stress and financial pressure to an already overcrowded system.
Data also showed "extensive buy downs," with enrollees moving to lower-tier or cheaper plans. Enrollment in Bronze plans increased by 11% and enrollment in Silver plans fell by 17%.
In states where Gold plan premiums were lower than Silver plans, membership in Gold plans increased by 6%.
The report comes amid increasing costs and the expiration of the enhanced premium tax credits.
The premium tax credits, also known as ACA subsidies, help lower or eliminate the out-of-pocket cost of monthly premiums for those who purchase insurance through the health insurance marketplace.
Eligibility for the subsidies can be determined by factors such as household income and geographic location.
The subsidies were part of the original ACA passed during the Obama administration. The amount of financial assistance was increased along with eligibility during the COVID-19 pandemic.
The majority of ACA marketplace enrollees were receiving enhanced premium tax credits to lower their monthly premiums, and many were preparing to see their premiums rise in 2026.
In October and November, the subsidies became a sticking point during the longest government shutdown in U.S. history.
Republicans said the expansions from the pandemic era went too far and tried to persuade Democrats to fund a temporary spending bill that didn't address the expiring ACA subsidies, with promises of discussing ways to continue the subsidies later.
Meanwhile, Democrats insisted on extending the premium tax credits as part of a bill to end the shutdown, warning that their expiration could be detrimental for millions of American families.
In early November, the Senate reached a bipartisan deal to end the shutdown -- which did not include any of the Democratic demands on health care. Eight Democrats voted with Republicans, and the bill was later also passed by the House.
Sources told ABC News that Republican leadership promised to allow a vote on a bill of Democrats' choosing related to the ACA in December, but a pair of competing health care-related bills failed to advance in the Senate earlier this month.
In January, the House passed a Democratic-led bill that would see the enhanced premium tax credits extended by three years. The bill has stalled in the Senate.
Estimates from the Congressional Budget Office have suggested that gross benchmark premiums -- the price of a standard plan before government subsidies are applied -- could increase by 4.3% in 2026 and by 7.7% in 2027 without an extension.
