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.

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.

Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.

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.

By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.

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.