Many Americans are feeling financial pain after the Affordable Care Act’s enhanced federal subsidies for marketplace health insurance expired.
About 1 in 10 people (9%) who enrolled in an ACA marketplace health plan last year is now uninsured because enhanced subsidies that lowered their monthly premiums expired, according to a new study from KFF, a nonpartisan health policy research group.
More people said they had downgraded their health insurance or faced financial stress due to rising medical costs, according to the poll.
According to KFF, the expiration of the enhanced premium tax credit more than doubled health insurance premiums for the average ACA enrollee in 2026. Approximately 22 million people, more than 90% of all ACA enrollees, received these subsidies last year.
“Re-admissions are really struggling financially,” said Luna Lopez, senior research manager at KFF.
KFF surveyed 1,117 U.S. adults enrolled in ACA marketplace health plans in 2025 to assess how they responded to market changes. The survey was conducted from February 12 to March 2, 2026.
Healthcare could influence midterm elections
An Obamacare sign stands in front of an insurance agency in Miami on November 12, 2025.
Joe Radle | Getty Images
Concerns about rising health care costs come as Americans grapple with affordability issues in other areas. The war with Iran, which began on February 28th between the United States and Israel, threatens to raise gasoline prices and increase inflation in food and other areas of household finances.
Health care costs, and broader affordability, are poised to become a powerful political force heading into this November’s midterm elections, political analysts say.
More than half of enrollees returning to the ACA marketplace (54% and 53%, respectively) hold Congressional Republicans and President Donald Trump “hugely” responsible for rising health care costs, according to the KFF poll.
While Democrats are more likely to blame Republicans and vice versa, independents are more likely to think Congressional Republicans and Mr. Trump deserve “a lot” of blame (56% and 58%, respectively) than Congressional Democrats (28%), according to the KFF poll.
The expiration of enhanced ACA subsidies became a central issue in the record-long government shutdown in the fall. Democrats pushed for an extension, but a majority of Republicans ultimately voted against it.
“We know how close some of this election is going to be,” Lopez said. “Changes in health insurance coverage and health care costs appear to influence how people approach elections, whether they go to vote, and who they vote for.”
Households make economic trade-offs
Lopez said households that choose to drop health insurance altogether because of rising costs face “a lot of anxiety and worry about what to do if they get sick.”
Even for those who had ACA health insurance, it was not without difficulty.
According to KFF, about 17% of re-enrollees said they were not confident in paying their premiums. They are at risk of losing their insurance this year, leaving more people uninsured, Lopez said.
The number of people enrolled in health insurance in the ACA markets is expected to decline to 12.5 million by 2028, the Congressional Budget Office estimated in February. This is about half of last year’s enrollment, and will nearly erase any increase in marketplace enrollment from 2021, when the enhanced subsidies take effect.
This decline in enrollment is due to the expiration of enhanced subsidies and other changes such as the Republican administration’s “Big and Beautiful Bill” action that will make it harder for many people to get and maintain insurance.
Approximately 28% of KFF survey respondents said they chose to maintain ACA Marketplace coverage but chose a different health plan.
ACA Marketplace plans are categorized into four tiers, or “metal levels”: Platinum, Gold, Silver, and Bronze.
According to health policy experts, many people have downgraded to bronze plans. Bronze plans generally have lower upfront premiums, but higher out-of-pocket costs if you need to use the insurance.
According to KFF, most people (55%) who re-enrolled in an ACA Marketplace plan in 2026 said they had reduced or planned to reduce basic household expenses such as food and clothing to cover medical costs.
According to the KFF survey, about 43% said they were or are trying to find additional work or work more hours, 23% said they skipped or delayed paying their bills, and 21% said they took out loans or increased credit card debt.
