Rising Health Costs: ACA Uninsured Rate Climbs to 1 in 10

Rising health insurance costs are creating a significant burden for many Americans, with a new survey revealing a growing number are struggling to maintain coverage through the Affordable Care Act (ACA) marketplaces. Approximately one in ten individuals who held ACA plans in the previous year are now uninsured, according to a recent report from the Kaiser Family Foundation (KFF).

The Impact of Subsidy Expiration

The increase in uninsured rates coincides with the expiration of enhanced tax subsidies that had lowered the cost of ACA insurance for millions of Americans. These subsidies, initially expanded during the COVID-19 pandemic, expired at the beginning of 2026, leading to a doubling of monthly premium payments for many enrollees, on average. This shift has prompted a reevaluation of coverage options for a substantial portion of the population.

The KFF survey, which followed up with 1,117 respondents from a larger poll conducted in late 2025, found that 51% of those who returned to a marketplace plan in 2026 reported “a lot higher” costs. A significant majority – 80% – indicated that their premiums, deductibles, or cost-sharing arrangements (copayments and coinsurance) had increased this year. These rising costs are not merely a financial concern. they are too fueling anxiety about accessing necessary care.

Concerns About Affording Care

The survey highlights a growing worry among ACA enrollees about their ability to afford healthcare services. Nearly three-quarters (73%) of respondents expressed concern about covering the costs of emergency care or hospitalizations, while almost half (49% and 45% respectively) worried about affording routine medical visits and prescription medications. This suggests that even having insurance doesn’t necessarily translate to feeling secure about healthcare affordability.

Interestingly, the KFF research also revealed that 17% of those who reenrolled in an ACA plan are unsure if they can afford their premiums for the entire year. A quarter of individuals who switched plans opted for a lower-tier metal plan, a move that typically results in lower premiums but higher out-of-pocket expenses when care is needed. This demonstrates a willingness to trade potential cost savings for increased financial risk.

Beyond Premiums: A Broader Affordability Challenge

The issue extends beyond just monthly premiums. The Affordable Care Act mandates that insurance plans cover a set of essential health benefits, including emergency care, hospitalization, maternity care, and prescription drugs, without annual or lifetime limits. While these benefits are crucial for comprehensive coverage, critics have long argued that they contribute to higher premiums. However, evidence connecting these essential health benefits directly to premium increases is mixed, and the relationship is not straightforward.

The debate over the ACA’s costs is particularly relevant now, as the expiration of the enhanced subsidies has brought the issue back into the political spotlight. Former President Donald Trump has repeatedly criticized the ACA, referring to it as the “unaffordable care act” and blaming it for “the crushing cost of health care.” These criticisms are echoed by some Republicans in Congress, while Democrats are using the situation to highlight the importance of affordable healthcare and pressure Republicans to address the issue.

Enrollment Trends and Future Outlook

The number of people enrolled in ACA coverage has already decreased by more than a million this year, and experts anticipate further declines as premiums come due. This trend raises concerns about the potential for increased uninsurance rates and reduced access to care, particularly among vulnerable populations. According to a KFF fact sheet, in 2025, roughly one-third of ACA enrollees indicated they would actively seek a lower-premium plan if their payments doubled.

Understanding Marketplace Dynamics

The ACA marketplaces offer a range of plans with varying levels of coverage and cost-sharing. Plans are categorized into metal tiers – Bronze, Silver, Gold, and Platinum – based on how they split the costs of healthcare with enrollees. Bronze plans typically have the lowest premiums but the highest out-of-pocket costs, while Platinum plans have the highest premiums but the lowest out-of-pocket costs. Choosing the right plan depends on an individual’s healthcare needs and financial situation.

What Comes Next: Policy and Monitoring

The current situation is prompting renewed scrutiny of the ACA and potential policy adjustments. Democrats are advocating for restoring the enhanced subsidies, while Republicans are exploring alternative approaches to lower healthcare costs. The upcoming November elections are likely to play a significant role in shaping the future of the ACA and healthcare affordability in the United States.

KFF and other organizations will continue to monitor enrollment trends, premium costs, and access to care in the ACA marketplaces. This ongoing surveillance is crucial for informing policy decisions and ensuring that Americans have access to affordable, quality healthcare. Further research is needed to fully understand the long-term impact of the subsidy expiration and the effectiveness of different strategies to address healthcare affordability. Individuals concerned about their coverage options should consult with a qualified insurance broker or visit HealthCare.gov for more information.