Insurance Without Security

Kate Bivona and her husband thought their Affordable Care Act plan would shield them from major medical costs. That confidence disappeared in January, when their monthly premium rose by roughly $300. Unable to afford the increase, the Arizona couple switched to a bronze plan that slashed their payments but left them facing an $18,000 annual deductible — a financial gamble Bivona says they are unprepared to take. “We would have to take out a loan,” said the 37-year-old musician.

Their situation mirrors a growing national trend. In 2026, state officials say more ACA enrollees are defaulting to bronze coverage after the expiration of enhanced subsidies pushed premiums higher, reversing years of preference for silver-tier plans and narrowing affordable choices.

Bronze plans cover all required ACA benefits but carry significantly higher out-of-pocket costs. In 2026, the average individual deductible for a bronze plan is about $7,500, according to KFF. Analysts at the organization, including ACA program director Cynthia Cox, note that the tier was originally intended for younger, healthier consumers — a profile that fits Bivona and her husband — but is now being chosen largely out of financial necessity.

Health policy experts have warned that widespread reliance on high-deductible plans may lead patients to delay care or take on medical debt, particularly those with chronic conditions. Lawrence Gostin, a professor at Georgetown University and a leading voice in health law, has long cautioned that high out-of-pocket costs can discourage timely treatment and worsen health outcomes. Similar concerns have been echoed by Howard Dean, the former Vermont governor and physician, who has argued that rising costs threaten the ACA’s promise of meaningful access to care.

Early federal data shows ACA enrollment down more than 800,000 compared with last year, while state figures from Rhode Island and California reveal sharp increases in bronze plan selection. Similar trends have been reported in Kentucky, Idaho, Massachusetts, New York and Virginia. Healthcare analysts, including KFF president Drew Altman, say remaining insured is still preferable to going without coverage, but affordability pressures continue to reshape how Americans access care.