Obamacare continues to shrink as enrollment opens for 2027

By Tami Luhby, CNN

(CNN) — Holly Hendricks, who is battling an autoimmune disease that leaves her with open wounds down to the muscle, did everything she could to maintain her Affordable Care Act coverage after the enhanced premium subsidies lapsed at the start of this year.

But after a few months, the 49-year-old couldn’t handle paying the monthly premiums, which had more than tripled to nearly $1,100. Hendricks, who also has lupus and rheumatoid arthritis, became uninsured for the first time in April.

While she scrapes together enough money to afford her 12 daily medications, Hendricks can no longer see her four specialists, get blood work, receive infusions or have a wound care nurse tend to her condition. In September, she developed sepsis and ended up in the hospital for a month, which she expects could saddle her with more than $500,000 in medical bills.

“Being insured is catastrophic to my health, but when you have to choose between rent, utilities, food and insurance – the more basic needs have to come first,” said Hendricks, a Sarasota, Florida, resident who works full-time as a caretaker for a veteran.

Faced with soaring premium payments after the beefed-up subsidies expired, millions of Obamacare enrollees left the market at the start of the year. Only 19.2 million people were enrolled as of February, down 2.6 million from the same period a year earlier, according to the latest federal data.

But there are multiple signs that enrollment has continued to fall since then, in part because policyholders like Hendricks couldn’t keep up with the higher monthly premiums amid rising costs for gas, groceries and other necessities.

“People who tried to make it work at the beginning of the year might not be able to make it work for a whole year,” said Cynthia Cox, director of the Program on the ACA at KFF, a nonpartisan health policy research group.

Some folks are hoping to resume their coverage in January if they can find a less expensive Obamacare plan. Open enrollment begins Sunday in most states, but premiums are expected to jump once again.

The ongoing enrollment decline comes as healthcare has been a key affordability issue in the midterm elections. Many Democratic candidates are highlighting that their Republican rivals allowed the enhanced premium subsidies to lapse, as well as voted to slash federal Medicaid funding by roughly $1 trillion as part of the One Big Beautiful Bill Act.

Republican-held congressional districts suffered disproportionately greater drops in enrollment between 2025 and 2026, KFF found. These districts account for 55% of enrollees but 67% of the declines. They tend to have higher shares of lower-income residents, who would have a tougher time affording any premium increases, Cox said.

Terminating coverage

Eighteen states that run their own Affordable Care Act exchanges reported that enrollment declines accelerated during the year due to more people dropping out and fewer signing up via special enrollment periods in 2026. Disenrollments were up nearly 34% as of May, compared to the same period a year prior, according to a State Marketplace Network report.

The number of people buying coverage on the individual market, which is largely comprised of the Obamacare exchanges, also fell – by more than 4.6 million as of June, compared to the same month a year earlier – according to KFF estimates.

Some states have seen steep declines. Mississippi, for instance, ended 2025 with 338,000 residents enrolled in Obamacare plans. By February, that figure had tumbled to fewer than 192,000 people and fell further to around 125,000 residents in September, Mike Chaney, the state’s insurance commissioner, told CNN. (Enrollment has since edged up to 135,000 people in late October.)

Massachusetts saw its first decline in enrollment during the course of the year outside of the Covid-19 pandemic period, said Audrey Morse Gasteier, executive director of the state’s Affordable Care Act exchange. About 8,000 fewer people were on the exchange in September than in February. The loss stems in part from more enrollees dropping their coverage mid-year than they typically do, she said.

Even New Mexico, which provides generous state-funded subsidies, saw continued disenrollments and fewer people signing up for coverage mid-year. It had been the only state where enrollment increased as of February, but that bump had largely disappeared by the fall, said Brent Earnest, interim CEO of BeWell, the state’s health insurance marketplace.

Kara Windeler is among those who desperately tried to keep her Obamacare coverage, which helped the Clearwater, Florida, resident treat her rheumatoid arthritis, long Covid, severe allergies and other conditions. Her premium jumped to $450 a month, from about $225 last year.

Unable to keep working as a skincare specialist because of her health, Windeler had been selling cherished collectibles, borrowing money from family and draining the proceeds of the 2024 sale of her house to pay her premiums. But the funds ran out so she will be uninsured as of November 1.

To prepare, Windeler filled 90-day prescriptions for her medications, saw her doctors and received a steroid injection in late October. She plans to ration the medicines so they last longer.

Windeler, an independent voter who turned 50 on Saturday, hopes that the Democrats will act to lower healthcare costs if they win control of Congress.

“There has to be something done so that people don’t die,” she said.

The Centers for Medicare and Medicaid Services, which oversees the Affordable Care Act exchanges, has attributed the enrollment declines to its anti-fraud efforts. It argues it is rooting out so-called phantom enrollees, who don’t exist, and people who were signed up without their knowledge by unscrupulous brokers seeking commissions.

In September, the White House fraud task force announced it was removing 760,000 enrollees from Obamacare coverage.

Premiums set to rise again

Premiums for Obamacare’s benchmark silver-tier plans will rise 13%, on average, in 2027, according to a KFF calculation of CMS and state exchange data. It’s the second consecutive year of double-digit premium increases and the 4th largest hike since the Affordable Care Act exchanges launched in 2014, Cox said.

Still, that’s far less than the 58% average jump in the monthly payments enrollees saw this year, which was exacerbated by the expiration of the enhanced premium subsidies. The lapsed assistance was more generous and helped more people than regular Obamacare subsidies, which were part of the 2010 law and continue to exist. Most enrollees still qualify for these regular subsidies, which will help shield them from the standard annual premium increase for next year.

In Idaho, premiums for silver-tier plans will be flat or lower than this year in many parts of the state once subsidies are factored in, said Pat Kelly, executive director of Idaho’s Obamacare exchange. While it’s too early to tell how many people will sign up, Kelly is encouraged by the fact that more people are reaching out to the call center and looking at the exchange’s website since enrollment opened on October 15.

Many enrollees nationwide, however, will have fewer plans to choose from since several large insurers have opted to pull out of some or all of the states where they provide coverage. Roughly 1,200 counties will have only one or two insurers on their exchanges, up from about 800, said Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation. That means enrollees could have to switch plans – so they need to check that their doctors and drugs are covered by the new policy.

Plus, those signing up for coverage could have less access to help since the Trump administration has placed a moratorium on new broker and agent participation in the exchanges as part of its fraud-fighting campaign. At the same time, it has slashed funding for navigators, who also provide enrollment assistance, by 90%.

Along with restrictions to immigrants’ eligibility for Obamacare subsidies stemming from the One Big Beautiful Bill Act, this means Affordable Care Act coverage is expected to shrink again next year. Younger, healthier people will likely be the ones to leave first, which could lead to higher premiums for those who remain.

Still, some Americans continue to rely on the Affordable Care Act.

Julie Kay Roberts has been waiting months for open enrollment to begin so she can look for a more affordable Obamacare plan. The consultant from Southlake, Texas, had to drop her coverage in June after being unable to keep up with monthly premiums that had soared from about $490 to $1,240.

Roberts is resigned to having to pay more out of pocket for care to have a plan with lower monthly premiums – even though she considers it more of a backstop in case of a catastrophe such as cancer or an accident. She’s hoping to find a plan that costs no more than $600 a month.

“I definitely will be finding an insurance option of some sort,” she said. “I just I don’t like to go without.”

The-CNN-Wire
™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.