ACA Marketplace Costs Surge: Survey Reveals Enrollee Struggles & Political Impact

The expiration of enhanced premium tax credits at the end of 2025 has led to significant increases in health care costs for many Americans enrolled in Affordable Care Act (ACA) Marketplace plans. A follow-up survey by KFF, re-interviewing over 80% of the original 1,350 enrollees, reveals a landscape of worry and financial strain as individuals navigate a changed marketplace. The survey findings, released in March 2026, paint a picture of rising premiums, deductibles and co-pays, forcing some to cut back on essential expenses or even forgo coverage altogether.

Rising Costs and Household Budgets

Half of those who have re-enrolled in ACA Marketplace coverage report that their overall health care costs are “a lot higher” this year. A substantial majority – 80% – say their 2026 plan’s premiums, deductibles, or cost-sharing are higher than in 2025, with 51% describing the increase as “a lot higher.” This increase isn’t just a matter of perception; it reflects the reality of the expired tax credits, which previously subsidized coverage for many enrollees.

The financial pressure extends beyond premiums. Three in four returning Marketplace enrollees express worry about affording emergency care or hospitalizations, while nearly half are concerned about covering routine medical visits (49%) or prescription drugs (45%). These anxieties are even more pronounced among those with lower incomes and chronic health conditions. Notably, 17% of returning enrollees aren’t confident they can afford their monthly premiums throughout the entire year.

To cope with these rising costs, many are making difficult choices. Over half (55%) of returning enrollees are cutting back on spending on food or basic household items to afford coverage and care. This figure rises to 62% for those with chronic health conditions. Some are taking more drastic measures, with 43% considering or seeking additional perform, 23% delaying other bill payments, and 20% resorting to loans or increased credit card debt.

Coverage Changes and the Uninsured

The increased costs are driving some enrollees to seek alternatives. Roughly 69% of 2025 Marketplace enrollees have re-enrolled for 2026, but nearly a third (28%) have switched to a different plan. A significant 9% are now uninsured. Cost is the primary driver behind these changes, with 34% of those who switched plans citing it as the main reason, and 71% saying it was a “major reason.” One individual from Texas, quoted in the KFF report, succinctly captured the situation: “The prices are simply too high. $800/month for the absolute cheapest plan for two people…We don’t qualify for subsidies in Texas. I don’t think we could afford our mortgage if I had to pay for health insurance.”

Younger adults are disproportionately leaving the Marketplace. Nearly half (49%) of enrollees aged 18-29 have left the Marketplace entirely, with 14% now uninsured. This trend aligns with KFF analysis suggesting insurers anticipated a healthier (and therefore less costly) enrollee base after the tax credit expiration, leading to premium increases.

Among those who remain in the Marketplace, a small but concerning 17% are not confident they can afford their premiums for the entire year. A further 4% haven’t yet paid their first premium for 2026, though many may be covered by a three-month grace period for nonpayment.

Political Implications and Blame

The financial strain caused by rising health care costs is not only impacting household budgets but also potentially influencing the political landscape. Nearly three-quarters (73%) of registered voters among 2025 Marketplace enrollees say the cost of health care will have at least a minor impact on their voting decisions in the 2026 midterm elections, and 74% say it will influence which party’s candidate they support. Democrats are significantly more likely than Republicans to view health care costs as a major voting issue (67% vs. 27%).

The survey reveals widespread dissatisfaction with Congress’s decision to let the enhanced premium tax credits expire, with 78% of enrollees believing it was the wrong move. This sentiment crosses party lines, with even a majority of Trump-supporting Republicans expressing disapproval.

When assigning blame for the increased costs, enrollees point fingers at a variety of actors. Health insurance companies are seen as largely responsible by most, but lawmakers and pharmaceutical companies also receive significant blame. Democrats overwhelmingly blame President Trump and Congressional Republicans, while Republicans tend to blame Congressional Democrats.

Navigating a Changed Marketplace

The KFF survey highlights the challenges facing individuals and families as they navigate the ACA Marketplace in the wake of the tax credit expiration. The process itself left many feeling worried (63%), angry (52%), and confused (46%). The data underscores the importance of understanding available options and seeking assistance when needed. Resources like KFF’s Affordable Care Act resources can provide valuable information and support.

The expiration of the enhanced tax credits and the resulting cost increases are likely to continue to shape the ACA Marketplace in the coming months and years. Ongoing monitoring of enrollment trends and affordability concerns will be crucial for policymakers and stakeholders as they consider potential solutions to ensure access to affordable health coverage. Further analysis of the impact of these changes, including the long-term effects on coverage rates and health outcomes, is needed to inform future policy decisions. The Medicaid expansion, currently adopted by 41 states and DC as of March 12, 2026, according to KFF, remains a critical component of expanding access to care for low-income individuals.

Looking ahead, the political response to these affordability concerns will be a key factor. The survey data suggest that health care costs are a potent issue for voters, and could significantly influence the outcome of the 2026 midterm elections.