Health care costs are significantly rising for many Americans who purchase insurance through the Affordable Care Act (ACA) marketplaces, according to a new survey from the Kaiser Family Foundation (KFF). The findings, released today, reveal that half of returning enrollees report their health care costs are “a lot higher” this year compared to last, following the expiration of enhanced premium tax credits. This increase is forcing many to make difficult financial trade-offs, impacting household budgets and raising concerns about access to care.
The KFF follow-up survey, conducted February 12-March 2, 2026, re-interviewed over 1,100 adults who had Marketplace coverage in 2025. It comes after open enrollment closed in most states and before grace periods for premium payments expire, offering a timely snapshot of the financial strain facing those relying on these plans. The survey highlights a growing affordability crisis, particularly as premium payments have more than doubled on average for those who didn’t receive enhanced tax credits, according to KFF analysis.
The impact isn’t uniform. Nearly one in six (17%) returning enrollees expressed a lack of confidence in their ability to afford their premiums this year. For those who maintained the same plan, the loss of enhanced tax credits has translated into a substantial financial burden. The survey also reveals a broader concern about healthcare affordability, with 73% of returning enrollees “highly worried” or “somewhat worried” about covering emergency care or hospitalizations, and nearly half (49% and 45% respectively) anxious about affording routine visits and prescription drugs.
Cutting Back to Cover Costs
Faced with higher premiums and out-of-pocket expenses, a majority (55%) of those who re-enrolled in an ACA Marketplace plan are already cutting back on other essential spending, or plan to do so, to afford their health care. This impact is even more pronounced for individuals with chronic health conditions, where over six in ten (62%) are reducing spending on necessities like food and other household basics. This underscores the difficult choices many are being forced to make between maintaining their health and meeting other fundamental needs.
Coverage Changes and Uninsured Rates
The financial pressures are leading some to alter their coverage. Approximately 9% of Marketplace enrollees have dropped their ACA coverage altogether and are now uninsured, while nearly 28% have switched to different plans. Cost was the primary driver for these changes, according to the survey. A 63-year-old man in California, quoted in the KFF report, explained his decision to proceed without insurance: “The end of ACA subsidies caused a huge increase in premiums, the cost of which I could not afford.” A 56-year-old man in Texas similarly described switching to a lower-tier plan, stating his premiums had tripled despite reduced benefits and a higher deductible.
Despite these challenges, the majority (69%) of those with 2025 Marketplace coverage have re-enrolled for this year. Others have found coverage through employers (5%), Medicare (4%), or Medicaid (7%). A modest percentage (5%) opted for plans outside the ACA Marketplace, which generally offer less comprehensive benefits and fewer consumer protections.
Political Implications and Voter Sentiment
The rising cost of health care is also shaping political attitudes. Seven in ten returning Marketplace enrollees who experienced higher costs blame health insurance companies “a lot” for the increases. A significant portion also place blame on congressional Republicans (54%), former President Trump (53%), and pharmaceutical companies (52%). Independents, in particular, are more likely to attribute blame to Republicans and Trump than to Democrats.
With the midterm elections approaching, health care costs are a significant issue for voters. Three-quarters of those with Marketplace coverage who are registered to vote say the issue will influence their decision, both in terms of whether to vote and which candidate to support. Democrats are significantly more likely than Republicans to view health care costs as a major voting factor, but the issue also resonates with nearly half of independent voters.
“The impacts on Marketplace enrollees we see in this follow-up survey will likely obtain worse as people struggle to make payments and the grace period many have expires,” said KFF President and CEO Drew Altman. The coming months will be critical as individuals navigate these increased costs and potential coverage disruptions.
Disclaimer: This article provides information about health insurance and is for general knowledge purposes only. It is not a substitute for professional medical or financial advice. Consult with a qualified healthcare provider or financial advisor for personalized guidance.
The full KFF survey data and analysis are available on the KFF website. Further updates on the ACA Marketplace and related policy changes will likely emerge as the year progresses.
What are your thoughts on the rising cost of healthcare? Share your experiences and perspectives in the comments below.
