ACA Costs Surge: Survey Reveals Impact on Marketplace Enrollees & 2026 Elections

Following the expiration of enhanced premium tax credits at the end of 2025, more than half of individuals who re-enrolled in Affordable Care Act (ACA) Marketplace health plans are experiencing significantly higher healthcare costs this year, according to a latest survey released Tuesday by the Kaiser Family Foundation (KFF).

The KFF follow-up survey, which re-interviewed 1,117 adults who had ACA Marketplace coverage in 2025, found that 51% of returning enrollees report their healthcare costs are “a lot higher” in 2026 compared to the previous year. Roughly four in ten (40%) specifically cited higher premiums as the primary driver of these increased costs. In total, 80% of returning enrollees indicated their overall healthcare costs – encompassing premiums, deductibles, co-pays, and coinsurance – have risen.

The survey was conducted between February 12 and March 2, 2026, and included responses gathered online and by telephone, in both English and Spanish. The findings come after a period of debate surrounding the expiration of the enhanced tax credits, which had lowered the cost of coverage for many enrollees. The expiration, despite a government shutdown over the policy, contributed to substantial premium increases for most individuals receiving subsidies.

Concerns about affordability are widespread among those who have maintained their Marketplace coverage. Nearly one in six (17%) returning enrollees expressed a lack of confidence in their ability to afford their premiums throughout the year. For those who kept the same plan, the loss of enhanced tax credits is estimated to have more than doubled annual premium payments on average.

In response to these rising costs, a majority (55%) of those who re-enrolled in an ACA Marketplace plan are making or planning to make cuts to essential household expenses, such as food, to afford their healthcare. This impact is even more pronounced for individuals with chronic health conditions, with over six in ten (62%) reporting they are already reducing spending on necessities.

The survey also revealed significant worry about affording both routine and emergency medical care. Approximately 73% of returning enrollees expressed “very” or “somewhat” worried about covering the costs of emergency care or hospitalizations, while nearly half (49%) and (45%) were concerned about affording routine medical visits and prescription drugs, respectively.

“The impacts on Marketplace enrollees we witness in this follow-up survey will likely acquire worse as people struggle to make payments and the grace period many have expires,” said KFF President and CEO Drew Altman.

The financial strain has already prompted some to alter their coverage. Roughly 9% of Marketplace enrollees have dropped their ACA coverage and are now uninsured, while another 28% have switched to different Marketplace plans. Cost was the primary reason cited for these changes.

A 63-year-old man in California, interviewed by KFF, explained his decision to develop into uninsured: “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 shared why he opted for a different Marketplace plan: “Income exceeded the subsidy limit, forcing us to pay the full cost, so we switched down to a bronze from a gold plan. Even doing that our premiums are 3 times what they were in 2025, with lower plan features and a higher deductible.”

69% of those who had ACA Marketplace coverage in 2025 have re-enrolled in a Marketplace plan for 2026. Others gained coverage through an employer (5%), Medicare (4%), or Medicaid (7%). A slight percentage (5%) purchased plans outside of the ACA Marketplace, which generally offer less comprehensive benefits and fewer consumer protections.

Looking ahead, the survey indicates that healthcare costs are poised to play a significant role in the upcoming elections. Seven in ten (70%) of returning Marketplace enrollees who are registered voters say healthcare costs will influence their voting decisions, and 74% say it will impact which party’s candidate they support. Democrats are more than twice as likely as Republicans to say this issue will have a major impact on their vote (67% vs. 27%) and candidate preference (70% vs. 30%). Among independent voters, nearly half (47%) say healthcare costs will significantly influence their vote, and 44% say it will affect their candidate choice.

When asked to assign blame for rising costs, seven in ten (70%) of returning Marketplace enrollees pointed “a lot” of blame at health insurance companies. At least half also attributed “a lot” of blame to congressional Republicans (54%), President Trump (53%), and pharmaceutical companies (52%). Independents were more likely to blame Congressional Republicans (56%) and President Trump (58%) than Congressional Democrats (28%).