Many Americans are feeling the financial pain following the expiration of enhanced federal subsidies for health insurance from the Affordable Care Act marketplace.
About 1 in 10 people (9%) who were enrolled in an ACA marketplace health plan last year are now uninsured following the expiration of enhanced subsidies that lowered their monthly premiums, according to a new survey by KFF, a nonpartisan health policy research group.
According to the survey, many more people said they have downgraded their health insurance or are facing financial stress due to higher health care costs.
The expiration of enhanced premium tax credits caused health premiums to more than double for the average ACA enrollee in 2026, according to KFF. About 22 million people (more than 90% of all ACA enrollees) received those subsidies last year.
“Returning members are really struggling with costs,” said Lunna Lopes, KFF senior survey manager.
KFF surveyed 1,117 American adults who were enrolled in an ACA marketplace health plan in 2025 to assess how they responded to changes in the marketplace. They were surveyed between February 12 and March 2, 2026.
Health care could influence midterm elections
An Obamacare sign in front of an insurance agency in Miami, on November 12, 2025.
Joe Raedle | fake images
Anxiety over higher health care costs comes as Americans face affordability issues in other areas. The war in Iran, launched by the United States and Israel on February 28, has raised gasoline prices and threatens to raise inflation in food and other areas of the household budget.
According to political analysts, health care costs (and affordability in general) are set to be a powerful political force ahead of this year's midterm elections in November.
More than half of enrollees returning to the ACA marketplace blamed congressional Republicans and President Donald Trump “a lot” (54% and 53%, respectively) for higher health care costs, according to the KFF survey.
While Democrats tended to blame Republicans, and vice versa, independents were more likely to say that congressional Republicans and Trump deserve “a lot” of blame (56% and 58%, respectively) than congressional Democrats, at 28%, KFF found.
The expiration of enhanced ACA subsidies was a central issue in the record-long government shutdown in the fall. Democrats pushed to extend them, but most Republicans ultimately voted against doing so.
“We know how close some of these elections could be,” Lopes said. “Changes in health care coverage and costs seem like something that will affect how they approach the election and whether they choose to vote, and who they choose to vote for.”
Households make financial trade-offs
Households that have chosen to drop their health insurance completely due to rising costs face “a lot of worries and concerns about what to do if they get sick,” Lopes said.
Even those who maintained their ACA health insurance coverage are not doing so without problems.
About 17% of returning enrollees said they are not sure they can pay their premiums, KFF found. They risk canceling their insurance this year, joining the ranks of the uninsured, Lopes said.
Total enrollment in ACA marketplace health plans is expected to fall to 12.5 million by 2028, the Congressional Budget Office estimated in February. That would be about half of last year's enrollment and would represent nearly erasing all gains in marketplace enrollment since 2021, when the enhanced subsidies went into effect.
That decline in enrollment is due to the expiration of enhanced subsidies and other changes, such as administrative measures in the GOP's “big, beautiful bill” that make it harder for many people to sign up for and keep their insurance.
About 28% of KFF respondents said they chose to keep ACA marketplace coverage but chose a different health plan.
ACA Marketplace plans are divided into four tiers, or “metal tiers”: platinum, gold, silver, and bronze.
Many people downgraded to bronze plans, which generally have lower initial premiums but cost more out of pocket when people need to use their insurance, according to health policy experts.
Most people (55%) who re-enrolled in an ACA marketplace plan in 2026 said they had cut back or planned to cut back on spending on basic household expenses, such as food and clothing, to help pay for their health care costs, according to KFF.
About 43% said they are trying or plan to try to find an extra job or work more hours, 23% said they are skipping or delaying paying bills, and 21% said they are taking out a loan or increasing their credit card debt, KFF found.
