ACA Marketplace Faces Headwinds: Rising Costs and Shifting Enrollment
The Affordable Care Act (ACA) Marketplace is navigating a challenging landscape as the expiration of enhanced premium tax credits sends shockwaves through enrollment and affordability. A recent follow-up survey by KFF reveals a significant increase in costs for many enrollees, leading to difficult choices and a potential shift in the political landscape.
Half of Marketplace Enrollees Report “A Lot Higher” Costs
The data is stark: half of those who re-enrolled in ACA Marketplace coverage for 2026 report their health care costs are “a lot higher” this year. This follows the end of enhanced premium tax credits at the close of 2025, which decreased financial assistance for subsidized plans. Eighty percent of returning enrollees noted an increase in premiums, deductibles, or cost-sharing compared to 2025, with over half stating the increase was substantial.
Financial Strain on Households
These rising costs aren’t just numbers on a bill; they’re impacting household budgets. A majority (55%) of returning Marketplace enrollees are cutting back on essential spending – food and basic household items – to afford coverage. This impact is even more pronounced for those with chronic health conditions, with 62% making similar cuts. Many are also considering or taking on extra work to manage expenses.
Coverage Changes and the Uninsured Rate
The financial pressure is driving changes in coverage. Roughly one in ten (9%) of 2025 Marketplace enrollees are now uninsured, and 28% have switched plans. Cost is the primary driver for these changes, with a 34-year-old Texan quoted in the KFF survey stating, “The prices are simply too high…we don’t qualify for subsidies in Texas.” Younger adults (ages 18-29) are particularly likely to have left the Marketplace, with nearly half (49%) now obtaining coverage elsewhere or becoming uninsured.
Worries About Affording Care
Even those who maintain Marketplace coverage are expressing significant worry. Three in four returning enrollees are “very worried” or “somewhat worried” about affording emergency care or hospitalizations, while nearly half are concerned about routine medical visits and prescription drugs. These anxieties are heightened among those with lower incomes and chronic health conditions.
Political Repercussions Loom
The expiration of the enhanced tax credits and the resulting cost increases are not going unnoticed by voters. Nearly three-quarters (73%) of registered Marketplace enrollees say the cost of health care will impact their vote in the upcoming midterm elections, and 74% say it will influence which party they support. Democrats are significantly more likely than Republicans to view health care costs as a major voting issue.
Blame Game: Who is Responsible?
Returning enrollees are assigning blame across the board. While health insurance companies receive significant criticism, many also point fingers at lawmakers and pharmaceutical companies. Democrats largely blame President Trump and Congressional Republicans, while Republicans tend to blame Congressional Democrats.
What’s Next for the ACA Marketplace?
The current situation raises questions about the long-term stability of the ACA Marketplace. The drop in enrollment, coupled with increased costs, could create a vicious cycle, potentially leading to further premium increases as healthier individuals opt out of coverage. The future will likely depend on policy decisions made at the federal and state levels.
Pro Tip:
If you’re experiencing difficulty affording your Marketplace coverage, explore all available options. Consider switching to a different plan tier, checking for additional state-based subsidies, or contacting your state’s health insurance marketplace for assistance.
Frequently Asked Questions
- What are the enhanced premium tax credits? These credits provided financial assistance to help lower monthly health insurance premiums for those purchasing coverage through the ACA Marketplace.
- Why did the enhanced tax credits expire? The credits were part of a temporary provision and were not extended by Congress.
- What is the impact of the expiration on enrollment? Enrollment has decreased, and more people are becoming uninsured or switching to different coverage options.
- Are there any options for those struggling to afford coverage? Explore different plan tiers, state-based subsidies, and assistance programs.
Wish to learn more? Explore additional resources on the KFF website and your state’s health insurance marketplace.
