A growing number of Affordable Care Act (ACA, or Obamacare) enrollees are selecting health plans with significantly higher deductibles as they shop the 2026 Marketplace. This trend appears tied to the expiration of enhanced premium tax credits, which kept out-of-pocket costs lower for many Americans over the past several years. With those subsidies gone, consumers face “sticker shock” on premiums and are turning to lower-cost plans that shift more costs to patients when care is needed. State officials and policy analysts say this shift could raise financial and health risks for enrollees.
Why This Is Happening
The policy environment for the ACA changed at the start of 2026, when enhanced premium tax credits—expanded during the pandemic era—expired at the end of 2025. Those credits had substantially reduced monthly premiums for many enrollees. Their loss means consumers often face much higher premiums if they remain in midtier plans, such as Silver tier. Many are instead choosing Bronze or other high-deductible options to keep monthly costs lower.
Deductibles for many of these plans are rising well above historical averages. According to Kaiser Family Foundation data, the weighted average for ACA Marketplace deductibles in 2026 is significantly higher than in previous years, especially for Bronze plans, which typically carry the lowest premiums and highest deductibles.
Consumer and Health Outcomes Implications
Evidence from research on high-deductible plans suggests that higher cost sharing can lead to delays in care and reduced utilization of preventive services. Some studies find that individuals with high out-of-pocket responsibilities under high-deductible plans tend to use fewer evidence-based health services and may have poorer outcomes, especially for chronic conditions.
For hospitals and health systems, this trend may translate into:
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Increased uncompensated care as patients defer needed care until conditions worsen.
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Greater reliance on emergency departments for care that might have been managed earlier and more cost-effectively in outpatient settings.
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More complex patient acuity when care is finally accessed.
Policy Context
Federal lawmakers have so far been unable to agree on a solution to restore the enhanced subsidies. Negotiations to extend the pandemic-era tax credits remain stalled in Congress, reducing prospects for near-term federal action to curb premium and deductible spikes.
Key Takeaways for Health System Leaders
• Monitor patient financial strain: Rising deductibles could increase financial barriers to care, especially for low-income and chronically ill patients.
• Prepare for shifts in care utilization: Expect potential increases in delayed care and later-stage presentations requiring more resource-intensive treatment.
• Community engagement and support: Enhance patient navigation resources and partnerships with community organizations to help patients understand plan differences and financial assistance options.
• Advocate for policy action: Engage with state and federal policymakers on stabilizing insurance markets and supporting affordability measures that reduce high-deductible plan prevalence.