Millions of Americans who buy health insurance through the Affordable Care Act marketplace are facing sharply higher costs in 2026 after enhanced premium tax credits expired at the end of 2025, according to a new KFF follow-up survey released Thursday.
KFF found the financial squeeze is forcing many families to cut basic expenses, downgrade coverage or go uninsured, with 80% of returning marketplace enrollees reporting that their 2026 premiums, deductibles, coinsurance or co-pays were higher than a year earlier, including 51% who said those costs were "a lot higher."
The nonprofit said the credits expired despite a government shutdown fight over the policy, ending a major source of financial help that had lowered what many subsidized enrollees paid each month for coverage.
The tax credits were first expanded in 2021 under the American Rescue Plan Act and later extended through the end of 2025 by the Inflation Reduction Act, and KFF estimated before the lapse that subsidized enrollees' annual premium payments would rise 114% on average in 2026, from $888 to $1,904, if Congress did not act.
KFF's new survey, published Thursday, found the higher costs are now colliding with everyday household budgets.
Among returning enrollees, 55% said they are or will be cutting back on food or other basic household items to afford coverage and care, while 17% said they were not confident they could keep up with their monthly premiums for all of 2026.
The anxiety extends beyond premiums alone.
KFF found 73% of returning enrollees said they were "very worried" or "somewhat worried" about paying for emergency care or hospitalization, while 49% worried about affording routine medical visits and 45% worried about prescription drug costs.
Many also described the shopping process itself as emotionally draining during open enrollment, with 63% saying they felt "worried," 52% saying they felt "angry" and 46% saying they felt "confused" as they evaluated their options for 2026 coverage.
Some consumers have decided they cannot make the math work at all.
KFF found 69% of 2025 marketplace enrollees reenrolled for 2026, including 28% who switched to a different marketplace plan, while 22% moved to another source of coverage and 9% said they are now uninsured.
A 34-year-old Texas man quoted in the survey summed up the pressure this way: "The prices are simply too high. $800/month for the absolute cheapest plan for two people. Our income is $120k, so we don't qualify for subsidies in Texas. I don't think we could afford our mortgage if I had to pay for health insurance."
The issue is also shaping the political landscape ahead of the 2026 midterm elections, with 48% of registered voters in the survey saying healthcare costs will have a major impact on whether they vote and 49% saying the issue will have a major impact on which party's candidate they support.
Even with the subsidy expiration, the marketplace remains a major source of coverage nationally, with CMS reporting 23 million plan selections for 2026, including 19.6 million people who had active 2025 coverage and either selected a new plan or were automatically reenrolled.
The KFF survey suggests that for many of those Americans, however, keeping that coverage now comes with harder tradeoffs and a growing sense that affordability, not access alone, may define the next phase of the ACA debate.
Theodore Bunker ✉
Theodore Bunker, a Newsmax writer, has more than a decade covering news, media, and politics.
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