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

Half of Americans who re-enrolled in Affordable Care Act (ACA) Marketplace health plans for 2026 are facing significantly higher healthcare costs this year, according to a new survey from the Kaiser Family Foundation (KFF). The findings come after enhanced premium tax credits expired at the end of 2025, leading to increased premiums for many subsidized enrollees.

The KFF survey, which re-interviewed 1,117 individuals – more than 80% of those initially surveyed in 2025 – reveals that 51% of returning Marketplace enrollees report that their premiums, deductibles, or co-pays are “a lot higher” compared to last year. An additional 29% say these costs are “somewhat higher.” The increases are straining household budgets, with 55% of returning enrollees reporting they are cutting back on spending on food or basic household items to afford coverage and care.

The expiration of the enhanced tax credits, despite a government shutdown over the policy in late 2025, has left many enrollees feeling financially vulnerable. “The prices are simply too high,” said a 34-year-old man in Texas, quoted in the KFF report. “$800/month for the absolute cheapest plan for two people. Our income is $120k, so 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.”

The impact isn’t uniform. Those with lower incomes and chronic health conditions are experiencing particularly acute financial pressure. 62% of returning enrollees with chronic conditions are cutting back on food and other household items to afford healthcare costs, compared to the overall average of 55%. 17% of returning enrollees are not confident they will be able to afford their monthly premiums for the entirety of 2026.

Some enrollees are attempting to mitigate the rising costs by downgrading their plans. A quarter of those who switched plans in 2026 opted for lower-tier “Bronze” plans, which typically have lower premiums but higher out-of-pocket costs. Though, even with these adjustments, many are still struggling.

The financial strain is driving some to leave the Marketplace altogether. 9% of 2025 Marketplace enrollees are now uninsured, and 28% have switched to a different plan. Cost was the primary driver for these changes, cited by a larger share of respondents than changes in healthcare needs. Younger adults, aged 18-29, are particularly likely to have left the Marketplace, with nearly half (49%) reporting they no longer have coverage through the ACA.

The rising costs are similarly fueling political discontent. 78% of 2025 Marketplace enrollees believe Congress made the wrong decision by allowing the enhanced premium tax credits to expire. This sentiment is widespread across party lines, with even a majority of Republicans and those who support the “Make America Great Again” movement agreeing that Congress erred.

Looking ahead to the 2026 midterm elections, 73% of registered voters who were enrolled in the Marketplace in 2025 say the cost of healthcare will have at least a minor impact on their vote, and 74% say it will influence which party’s candidate they support. Democrats are significantly more likely than Republicans to view healthcare costs as a major voting issue, with 67% saying it will have a major impact on their decision to vote, compared to 27% of Republicans.

The KFF survey also revealed a degree of frustration with the open enrollment process itself, with 63% of 2025 Marketplace enrollees reporting they felt “worried” while searching for coverage and 52% feeling “angry.” Many expressed anger and disappointment at the government’s failure to extend the tax credits, and at the increased costs they faced as a result.

As of March 2026, the House of Representatives has passed legislation to extend the expired subsidies, but negotiations have moved to the Senate, leaving the future of affordable healthcare coverage uncertain for millions of Americans.