ACA Marketplace Struggles: Rising Costs Force Coverage Cuts and Fuel Political Debate
The expiration of enhanced premium tax credits at the end of 2025 is sending shockwaves through the Affordable Care Act (ACA) Marketplace, leaving many enrollees facing significantly higher costs and difficult choices. A new KFF follow-up survey reveals a concerning trend: half of returning enrollees report “a lot higher” healthcare costs this year, with four in ten specifically citing increased premiums.
Financial Strain on Households
The financial burden is substantial. More than half (55%) of those who re-enrolled in an ACA Marketplace plan are cutting back on basic household expenses – like food and clothing – to afford their healthcare. This impact is even more pronounced for individuals with chronic health conditions, where over six in ten (62%) are making similar sacrifices.
The situation is dire enough that nearly one in ten (9%) people who were enrolled in ACA plans last year have dropped their coverage altogether, becoming uninsured. An additional 17% are at risk of doing the same due to affordability concerns.
Real Stories of Impact: A 63-year-old Californian shared with KFF, “The end of ACA subsidies caused a huge increase in premiums, the cost of which I could not afford.” A 56-year-old Texan explained, “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.”
Plan Changes and Uninsured Rates
Beyond dropping coverage, many are altering their plans. Almost three in ten (28%) returning enrollees have switched Marketplace plans, primarily due to cost. In total, 69% of those with 2025 ACA Marketplace coverage have re-enrolled, while others have found coverage through employers (5%), Medicare (4%), or Medicaid (7%). A small percentage (5%) opted for plans outside the ACA Marketplace, which typically offer less comprehensive benefits.
Political Fallout and Voter Concerns
The rising costs are not only impacting household budgets but similarly shaping political sentiment. Seven in ten (70%) of those who experienced higher health costs blame health insurance companies “a lot.” Significant blame is also directed towards Congressional Republicans (54%), President Trump (53%), and pharmaceutical companies (52%). Independent voters are particularly likely to blame Congressional Republicans (56%) and President Trump (58%).
Healthcare costs are poised to be a major factor in upcoming elections. Three-quarters (73%) of those with prior Marketplace coverage and who are registered to vote say these costs will influence their voting decisions, and 74% say it will impact which party they support. Democrats are more strongly affected, but nearly half of independent voters also report a significant impact.
Worries About Affording Care
Beyond premiums, enrollees are anxious about affording care itself. Three-quarters (73%) are “extremely worried” or “somewhat worried” about covering emergency care or hospitalizations. Nearly half (49%) are concerned about routine visits and 45% about prescription drugs.
Looking Ahead: Potential Future Trends
The current situation suggests several potential future trends. Continued pressure on the ACA Marketplace could lead to further increases in uninsured rates, particularly among lower-income individuals and those with pre-existing conditions. We may see a shift towards lower-tier plans (bronze or silver) as people seek more affordable options, potentially sacrificing coverage benefits.
The political implications are also significant. Healthcare is likely to remain a central issue in elections, and public dissatisfaction with rising costs could drive demand for policy changes, such as renewed subsidies or efforts to control prescription drug prices. The long-term stability of the ACA Marketplace will depend on addressing these affordability challenges.
FAQ
- What caused the increase in ACA Marketplace costs? The expiration of enhanced premium tax credits at the end of 2025 significantly increased premiums for many enrollees.
- How many people dropped their ACA coverage? Approximately 9% of those enrolled in ACA plans in 2025 dropped their coverage in 2026.
- Are people cutting back on other expenses to afford healthcare? Yes, 55% of those who re-enrolled in an ACA Marketplace plan are cutting or planning to cut spending on basic household expenses.
- Is healthcare a major voting issue? Yes, 73% of those with prior Marketplace coverage and who are registered to vote say healthcare costs will affect their voting decisions.
Explore further: Learn more about the Affordable Care Act and related research from KFF.
