A little more than half of Affordable Care Act (ACA) marketplace enrollees reported cutting back on spending for food, clothing and other basic household items to afford health care, which has become more expensive.
In a new KFF poll released Thursday, 55 percent of returning ACA marketplace enrollees said they are already or are planning to cut back on food or basic household items so they can afford health care-related costs, with half of those surveyed saying their health care costs are “a lot” higher in 2026.
Roughly 4 in 10 survey participants said they have already or are planning to find an extra job or work additional hours because of higher health care spending. About the same amount of participants reported that their deductibles had gone up this year.
Among surveyed 2026 ACA marketplace enrollees, the vast majority — 78 percent — said they thought Congress did the wrong thing by letting the subsidies expire. Ninety-four percent of Democratic enrollees said it was wrong, while 58 percent of Republicans said the same.
About the Survey
At the end of 2025, despite a government shutdown over the policy, the enhanced premium tax credits expired, decreasing financial assistance for subsidized Marketplace enrollees and contributing to significant increases in the Affordable Care Act (ACA) Marketplace costs for most enrollees overall. Amid the debates leading up to the expiration, KFF conducted a probability-based survey of 1,350 adults covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace.
This report is based on all 2025 Marketplace enrollees who took the follow-up survey, including returning Marketplace enrollees1, those who have left the Marketplace entirely for another type of coverage, and those who are now uninsured.
About the Survey
At the end of 2025, despite a government shutdown over the policy, the enhanced premium tax credits expired, decreasing financial assistance for subsidized Marketplace enrollees and contributing to significant increases in the Affordable Care Act (ACA) Marketplace costs for most enrollees overall. Amid the debates leading up to the expiration, KFF conducted a probability-based survey of 1,350 adults covered by ACA Marketplace plans in late 2025 to better understand their worries about potential cost increases for their health coverage. Now—without the enhanced tax credits in place—KFF re-interviewed 1,117 individuals (more than 80% of the original sample) to learn how they are navigating these changes to the ACA Marketplace.
This report is based on all 2025 Marketplace enrollees who took the follow-up survey, including returning Marketplace enrollees1, those who have left the Marketplace entirely for another type of coverage, and those who are now uninsured.
Returning Marketplace Enrollees Are Paying More for Their 2026 ACA Coverage and Will Cut Back on Spending; Many Not Confident They Can Afford Premiums All Year
Percent of returning Marketplace enrollees who report each of the following:
Bar chart showing health care cost concerns among 2025 ACA Marketplace enrollees who still have Most 2025 Marketplace Enrollees Still Have Marketplace Coverage, Though One in Ten Are Now Uninsured
Current health insurance coverage for 2025 Marketplace enrollees:
Bar chart showing health insurance coverage type among 2025 Marketplace enrollees.
Marketplace coverage
69%
Same Marketplace plan
39%
Switched Marketplace plans
28%
Other type of coverage
22%
Medicaid
7%
Non-Marketplace, purchased plan
5%
Employer-sponsored insurance
5%
Medicare
4%
Insurance through parents
coverage.Higher health care costs
Total who report higher health care costs
80%
Their costs are "a lot" higher
51%
Affordability concerns
Worried about affording costs for emergency care or hospitalizations
73%
Worried about affording costs for routine medical care
49%
Worried about affording costs for prescription drugs
45%
They are, or will be, cutting back on household spending to afford health care costs
55%
They are not confident they can afford their premium all year
17%
Note: Among 2025 Marketplace enrollees who still have Marketplace coverage. See topline for full question wording.
Some previous ACA Marketplace enrollees are now uninsured or have changed to a different Marketplace plan, citing costs as the major reason for that decision. One in ten (9%) 2025 Marketplace enrollees say they are now currently uninsured and three in ten (28%) say they switched to a different Marketplace plan. When asked the reasoning behind their change, a larger share say costs were the driver rather than changes to their health care needs. A 34-year-old man living in Texas put it this way, “The prices are simply too high. $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.”
Health care costs may be a deciding factor for ACA Marketplace enrollees in the 2026 midterm elections. With health care costs front and center for 2025 Marketplace enrollees, many who are registered to vote say that the cost of health care will have a major impact on their decision to vote (48%) and which party’s candidate they will support (49%) in the midterm elections. The issue currently resonates more with Democrats, who are more than twice as likely as Republicans to say health costs will play a major impact on their decision to vote in the 2026 midterms (67% vs. 27%) and on which candidate they decide to vote for (70% vs. 30%).
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