Health insurance dominated the news in the last few months of 2025. With the Affordable Care Act (ACA) enhanced premium tax credits expiring on the first day of the new year, the future of individual insurance was up for debate. Would the ACA Marketplace survive a sudden drop in sign-ups if people were no longer able to afford premium payments?
Leading into open enrollment, plenty of doomsayers predicted that the individual market would collapse under the pressure, leaving millions without coverage. Others took a more moderate stance, forecasting rising costs but an enduring market.
With data from open enrollment now coming in, we no longer need to rely on guesswork. Let’s take stock of where the ACA Marketplace stands today and what it means for our healthcare system.
1. The individual market survived
ACA enrollment is lower this year compared to 2025, but it’s far from the catastrophic collapse many predicted. According to the Centers for Medicare & Medicaid Services (CMS), 23 million people signed up for individual market health insurance coverage through HealthCare.gov or a state-based exchange, 3.4 million of whom are new to the Marketplace for 2026.
That slight drop in enrollment has reduced the size of risk pools and, in some cases, increased costs per policyholder. But the 2026 Marketplace Open Enrollment Period (OEP) was a major stress test, and the individual market made it through.
There’s reason to believe this dip in enrollment is temporary and that the market will bounce back. As we head into the midterm elections, politicians are focused on cost of living and making health insurance more accessible to everyone. These efforts should lead to increased affordability, higher participation in the ACA Marketplace, and a return to larger risk pools and lower premiums.
2. Some states fared better than others
The impact of expired enhanced premium tax credits on the individual market varies from state to state. According to data from some of the states that operate their own exchange, North Carolina saw the greatest drop in enrollment — almost 22% year-over-year.
In other states, the number of people purchasing an ACA health plan actually increased. California, Maryland, Texas, and the District of Columbia all reported higher enrollment compared to 2025. New Mexico, the only state to fully offset the reduction in federal subsidies for its residents, saw the biggest increase in marketplace participation.
States where ACA enrollment is trending upwards could be fertile ground for HRAs. With rising healthcare costs pushing up group plan premiums, more and more employers are looking for an alternative. HRAs help employers stabilize costs while also ensuring employees get access to their preferred level of coverage.
3. High-deductible plans gained
Health insurance on the individual market may be more expensive than it was 12 months ago, but that hasn’t led to a mass exodus. In many cases, people kept their coverage but switched from gold or silver plans to bronze plans with lower premiums and higher out-of-pocket costs.
According to the State Marketplace Network, bronze plan enrollment in Maine increased 10 percentage points and now represents almost 60% of all selected plans. In California, 73% of enrollees who changed plans moved to a bronze-tier plan compared to 27% last year. New consumers are also prioritizing lower premiums — 38% of Rhode Island’s new members chose bronze coverage, up from 15% in 2025.
This data highlights one of the key advantages of individual coverage: consumers can choose to lower their monthly premium costs without losing access to essential medical services. Group insurance provides employees with a black-or-white choice: either pay for the coverage or go without. HRAs offer a wider range of options, allowing employees to avoid coverage they don’t need or can’t afford.
High-deductible plans are likely to continue gaining momentum. New rules recently proposed by CMS in the 2027 Notice of Benefit and Payment Parameters (NBPP) would greatly expand the flexibility of high-deductible bronze and catastrophic plans. These plans pair really well with HRA solutions, especially ones that allow for medical expense reimbursements.
4. We won’t know the full picture for weeks
While there is already some useful data coming in, it will still be weeks before we have all the information. Many existing policyholders were automatically reenrolled in their ACA health plans for 2026, and until these enrollees pay — or don’t pay — their premiums, we won’t know exactly how many Americans are covered. Some consumers may choose to cancel their coverage instead of paying a higher premium. In other cases, insurance companies will cancel plans as a result of non-payment.
This year’s open enrollment represented a historic threat to the individual market, but the ACA survived. That resilience demonstrates the critical role of the individual market in providing access to health coverage in this country. As politicians look to make life more affordable for residents, they should start by stabilizing the individual market and lowering the cost of coverage for the people who need it most.
Photo: fstop123, Getty Images
Jack Hooper is the CEO and co-founder of Take Command, a Dallas-based SaaS company that offers health reimbursement arrangement administration. Jack is a founding member of the HRA Council and has served as Chairman of the Board. He is a graduate of the Wharton School of Business and has been featured in The New York Times, BenefitsPro, Dallas Morning News, Bloomberg, and more. His motto? “Health insurance was never meant to be this complicated.”
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