ACA enrollees go uninsured after enhanced subsidies expire: KFF poll
Many Americans are feeling financial pain following the end of enhanced federal subsidies for Affordable Care Act marketplace health insurance.
Nearly 1 in 10 (9%) people who enrolled in an ACA marketplace health plan last year are now uninsured following the end of enhanced subsidies that reduced their monthly premiums, according to a new survey from KFF, a nonpartisan health policy research group.
Many more people said they had downgraded their health insurance or faced financial stress due to the high costs of health care, according to the survey.
The expiration of enhanced premium tax credits caused health premiums to more than double for the average ACA enrollee in 2026, according to KFF. Nearly 22 million people (more than 90% of all ACA enrollees) received these benefits last year.
“Returning students are really struggling with costs,” said Lunna Lopes, KFF senior survey manager.
KFF surveyed 1,117 U.S. adults enrolled in an ACA marketplace health plan in 2025 to gauge how they responded to changes in the marketplace. They were surveyed between February 12 and March 2, 2026.
Health care could affect midterm elections
An Obamacare sign stands outside an insurance agency in Miami, November 12, 2025.
Joe Raedle | Getty Images
Concern about higher health care costs comes as Americans grapple with health issues affordability in other areas. The war in Iran, launched by the United States and Israel on February 28, has increased gasoline prices and threatened to increase inflation in groceries and other areas of the household budget.
Health care costs, and affordability more generally, are poised to be a powerful political force ahead of this year’s midterm elections in November, according to political analysts.
More than half of returning ACA enrollees blame congressional Republicans and President Donald Trump (54% and 53%, respectively) “a lot” for high health care costs, according to the KFF survey.
While Democrats tend to blame Republicans (and vice versa), independents are more likely to say Republicans in Congress and Trump deserve “a lot” of blame (56 percent and 58 percent, respectively), by 28 percent than congressional Democrats, KFF found.
The end of increased ACA subsidies was a central issue during 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 these elections can be,” Lopes said. “Changes in health care coverage and health care costs seem like something that will impact how they approach the election, whether they decide to participate and vote, and who they may choose to vote for.”
Households make financial trade-offs
Households who choose to drop health insurance altogether because of rising costs face “a lot of worries and concerns about what to do if they get sick,” Lopes said.
Even those who maintain ACA health insurance coverage do not do so without problems.
About 17% of returning enrollees said they were unsure if they could afford their premiums, KFF found. Lopes said they are at risk of losing their insurance this year, which will add them to the uninsured.
Total enrollment in ACA marketplace health plans: It is expected to decrease to 12.5 million by 2028Congressional Budget Office estimate in February. This would be about half of last year’s registrations and represents a near-erasure of all gains in registrations for the market since 2021, when increased subsidies took effect.
This enrollment decline is due to the end of increased subsidies and other changes in the GOP’s “big beautiful bill,” such as executive measures that make it harder for many people to sign up for and keep insurance.
About 28% of KFF survey respondents said they preferred to keep ACA marketplace coverage but chose a different health plan.
ACA marketplace plans are divided into four tiers or “metal levels”: platinum, gold, silver and bronze.
Many people have switched to bronze plans, which typically have lower up-front premiums but cost more out-of-pocket when people need to use their insurance, health policy experts say.
According to KFF, a majority (55%) of people re-enrolling in an ACA marketplace plan in 2026 said they have cut back or plan to cut back on essential household expenses like food and clothing to cover health care costs.
About 43 percent said they tried or planned to get an extra job or work more hours, 23 percent said they skipped or postponed paying their bills, and 21 percent said they took out a loan or increased their credit card debt, KFF found.
