ACA Costs Surge, Forcing Americans to Build Difficult Choices
Millions of Americans are facing significantly higher healthcare costs in 2026 after enhanced premium subsidies for Affordable Care Act (ACA) Marketplace plans expired at the end of 2025. A recent follow-up survey by the Kaiser Family Foundation (KFF) reveals the financial strain these changes are placing on individuals and families.
Rising Costs and Coverage Decisions
According to the KFF survey, over half (51%) of returning ACA Marketplace enrollees report that their healthcare costs are “a lot higher” this year compared to 2025. Specifically, 40% noted that their premiums are “a lot higher.” In total, 80% of enrollees are experiencing increased healthcare costs, encompassing premiums, deductibles, copayments, and coinsurance. KFF conducted the survey between February 12 and March 2, 2026, among 1,117 U.S. Adults who were enrolled in an ACA marketplace health plan in 2025.
The expiration of enhanced premium tax credits has, on average, more than doubled annual premium payments for ACA enrollees in 2026. Nearly one in six (17%) returning enrollees are unsure if they can afford their premiums throughout the year. Approximately 9% of those enrolled in ACA plans in 2025 are now uninsured, and an additional 17% are at risk of losing coverage due to affordability concerns. CNBC reported these findings on March 19, 2026.
Impact on Household Budgets
To cope with rising healthcare expenses, a majority (55%) of those who re-enrolled in an ACA Marketplace plan are cutting back on spending for essential household items like food and clothing. This impact is even more pronounced for individuals with chronic health conditions, with over six in ten (62%) making similar cuts. Fierce Healthcare detailed these financial adjustments on March 20, 2026.
Concerns About Access to Care
Beyond premiums, enrollees are worried about affording medical care itself. Approximately 73% of returning Marketplace enrollees expressed concern about covering the costs of emergency care or hospitalizations. Nearly half (49%) are worried about affording routine medical visits, and 45% are concerned about prescription drug costs.
Shifting Coverage and Blame
Some individuals have responded to the increased costs by changing their coverage. A quarter of those who switched plans downgraded to a lower metal tier, opting for plans with lower premiums but higher out-of-pocket costs. Around 28% changed Marketplace plans altogether, while 9% dropped their ACA coverage entirely. 5% obtained coverage through an employer, 4% through Medicare, and 7% through Medicaid.
When asked about the reasons for rising costs, a majority of enrollees (70%) place “a lot” of blame on health insurance companies. At least half likewise blame Congressional Republicans (54%), former President Trump (53%), and pharmaceutical companies (52%).
Healthcare Costs and the Midterm Elections
Healthcare costs are poised to be a significant factor in the upcoming midterm elections. Three-quarters (73%) of those with Marketplace coverage who are registered to vote say healthcare costs will influence their voting decisions, and 74% say it will impact which party’s candidate they support. Democrats are more likely than Republicans to view healthcare costs as a major voting issue.
“The impacts on Marketplace enrollees we see in this follow-up survey will likely get worse as people struggle to make payments and the grace period many have expires,” said KFF President and CEO Drew Altman.