According to a Commonwealth Fund survey of more than 25,000 adults, 4 in 10 Americans cite health insurance costs as the single biggest problem facing the U.S. health system, creating widespread financial anxiety across political lines.
ACA Subsidy Expiration Drives Up Marketplace Premiums
The expiration of enhanced federal subsidies at the end of 2025 sent shockwaves through the insurance marketplace. According to data from the health policy nonprofit KFF, average costs for Affordable Care Act enrollees who wanted to keep their coverage soared 114% in 2026. The sudden price hike forced more than 3 million enrollees to drop their coverage as of February, according to tracking cited by the Commonwealth Fund.
“If people aren’t able to afford their ACA premiums, and we’re already seeing evidence of that, they’re going to become uninsured,” said Sara Collins, senior scholar for expanding coverage and access at the Commonwealth Fund. Over half of survey participants who bought marketplace or direct-purchase plans cited cost as their primary worry.
Rising Workplace Insurance Costs Hit Working Families
Employer-sponsored insurance remains the primary coverage vehicle for working-age adults, but those costs are climbing rapidly. According to projections from the consultant Mercer, companies expect health insurance expenses for employees to rise nearly 7% in 2026, pushing the total benefit cost to about $18,500 per employee. Data from the Commonwealth Fund indicates that 44% of workers who receive insurance through their jobs view plan costs as their top financial concern, forcing employees to shoulder larger paycheck deductions.
Did you know? While employer-sponsored insurance covers the majority of working-age adults, about 38% of insured adults under age 65 worry about affording their monthly premiums, rating their coverage as fair or poor regarding out-of-pocket expenses, according to KFF polling data.
Medicaid Work Requirements Threaten Coverage for Millions
Government-funded insurance is undergoing strict contraction alongside private market changes. Under a provision in the 2025 federal budget bill, millions of Medicaid recipients must now complete work, job training, or volunteering requirements to maintain benefits. The Congressional Budget Office projects that out of 18.5 million people subject to these new mandates, more than 5 million will lose their Medicaid coverage by 2034.
Beyond premiums, out-of-pocket expenses continue to squeeze household budgets. Approximately 36% of survey respondents identified co-pays and deductibles for lab tests, doctor visits, and prescription drugs as their second-biggest health system worry. KFF findings show these financial pressures lead roughly 43% of adults to skip medications, split pills, or rely on over-the-counter alternatives due to cost.
Political Divides Over Health Affordability Solutions
While voters across party lines agree that costs are out of control, Democrats and Republicans disagree sharply on who should fix the system. Survey data reveals that 65% of Democrats believe the federal government is best equipped to lower health insurance costs. Conversely, only 36% of Republicans favor government intervention, with Republican respondents proving twice as likely as Democrats to look to private insurance companies for solutions.
Frequently Asked Questions
Why did Affordable Care Act insurance costs increase in 2026?
ACA costs rose because Congress allowed enhanced federal subsidies to expire at the end of 2025, causing average premiums for remaining enrollees to jump 114%, according to KFF.
How many people dropped their ACA coverage?
More than 3 million ACA enrollees dropped their health insurance plans as of February due to higher monthly premiums and the expiration of financial assistance, according to data cited by the Commonwealth Fund.
What are the new rules for Medicaid recipients?
A provision in the 2025 federal budget bill requires up to 18.5 million Medicaid recipients to work, complete job training, or volunteer to keep their government-funded health insurance.
Who do voters believe should fix health care costs?
According to Commonwealth Fund polling, 65% of Democrats look to the federal government to solve insurance cost issues, whereas Republicans are twice as likely as Democrats to believe private insurance companies should address premium prices.
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