Many Americans are feeling the financial pain following the expiration of enhanced federal subsidies for Affordable Care Act marketplace health insurance.
About 1 in 10 people — 9% — who were enrolled in an ACA marketplace health plan last year are now uninsured following the lapse of enhanced subsidies that reduced their monthly premiums, according to a new survey by KFF, a nonpartisan health policy research group.
Many more people said they downgraded health insurance or face financial stress due to higher costs for health care, according to the poll.
The lapse of enhanced premium tax credits led health premiums to more than double for the average ACA enrollee in 2026, according to KFF. About 22 million people — more than 90% of all ACA enrollees — received those subsidies last year.
“Returning enrollees are really struggling with costs,” said Lunna Lopes, a senior survey manager at KFF.
KFF polled 1,117 U.S. adults who were enrolled in an ACA marketplace health plan in 2025 to gauge how they responded to changes in the marketplace. They were surveyed between Feb. 12 and March 2, 2026.
Health care could sway midterm elections
An Obamacare sign sits in front of an insurance agency on Nov. 12, 2025 in Miami, Florida.
Joe Raedle | Getty Images
The anxiety over higher health care costs comes as Americans were already nervous about affordability. The war in Iran, initiated by the U.S. and Israel on Feb. 28, has also driven up gasoline prices and threatens to raise inflation for groceries and other areas of household budgets.
Health care costs — and affordability more broadly — are poised to be a potent political force ahead of this year’s midterm elections in November, according to political analysts.
More than half of returning enrollees to the ACA marketplace put “a lot” of blame on congressional Republicans and President Donald Trump — 54% and 53%, respectively — for higher health care costs, according to the KFF poll.
While Democrats tended to blame Republicans, and vice versa, independents were more likely to say congressional Republicans and Trump deserve “a lot” of blame (56% and 58%, respectively) than congressional Democrats (28%), KFF found.
The expiration of enhanced ACA subsidies was a central issue in the record-long government shutdown in the fall. Democrats pushed to extend them, but a majority of Republicans ultimately voted against doing so.
“We know how close some of these elections could be,” Lopes said. “Changes in health care coverage and health care costs do seem like something that will impact how they approach the election and whether they decide to turn out and vote — and who they may choose to vote for.”
Households make financial tradeoffs
Households that chose to drop their health insurance altogether due to rising costs face “a lot of concerns and worries about what to do if they get sick,” Lopes said.
Even those who kept their ACA health insurance coverage aren’t doing so painlessly.
About 17% of returning enrollees said they aren’t confident they can afford their premiums, KFF found. They’re at risk of dropping their insurance this year, adding to the ranks of the uninsured, Lopes said.
Total enrollment in ACA marketplace health plans is expected to fall to 12.5 million by 2028, the Congressional Budget Office estimated in February. That would be about half of last year’s enrollment and represent a near-erasure of all gains in marketplace sign-ups since 2021, when the enhanced subsidies took effect.
That enrollment reduction is due to the lapse of enhanced subsidies and other changes, like administrative measures in the GOP’s so-called “big beautiful bill” that make it harder for many people to sign up for and keep their insurance.
Another 28% of KFF survey respondents opted to keep ACA marketplace coverage but chose a different health plan.
ACA marketplace plans fall into four tiers, or “metal levels”: Platinum, gold, silver and bronze.
Many people downgraded to bronze plans, which generally have lower upfront premiums but cost more out-of-pocket when people need to use their insurance, according to health policy experts.
Most people — 55% — who reenrolled in an ACA marketplace plan in 2026 said they’ve cut or plan to cut spending on basic household expenses like food and clothing in order to afford their health care costs, according to KFF.
About 43% are trying or plan to try to find an extra job or work more hours, while 23% are skipping or delaying paying bills, and 21% are taking out a loan or increasing their credit card debt, KFF found.
