Poll finds ACA enrollees cutting food and skipping care as subsidies end

Poll shows Americans cutting back on basics as ACA costs rise

Many Americans who re-enrolled in Affordable Care Act marketplace coverage are contending with higher premiums and out-of-pocket costs, according to a new survey by the health care research nonprofit KFF. The survey, conducted in February and March and based on follow-up interviews with people who took part in a KFF marketplace survey last year, finds that the change is reshaping day-to-day household decisions, particularly as enhanced tax credits that had helped offset premiums expired after Dec. 31.

In Orlando, Florida, Priscilla Brown, a 48-year-old truck dispatcher who said she has type 2 diabetes, described having to ration her care. She said she has taken half or even a third of her prescribed insulin dose on some days to make it last longer, and she said, “Sometimes I don’t even take my medicine.” She added, “It’s so much with insurance, it’s crazy.” Brown also described how the cost of the medication rose from the period when she said she paid nothing toward premiums to her current plan costs.

KFF said the survey results reflect what happens after the Dec. 31 expiration of enhanced tax credits that had offset premiums for most enrollees. The survey reported that last year Brown paid zero dollars toward her health insurance premiums, but that this year her plan costs $17 a month and comes with a higher deductible. She said she learned her refill would cost more than $150 and that she “almost passed out,” and she described cutting back on gasoline purchases so she could reserve money for medications.

The KFF survey found that nearly everyone who returned to ACA coverage expects to feel the pinch. It reported that about 8 in 10 Americans who re-enrolled in ACA marketplace coverage say their health care costs are higher this year, including about half who say the costs are “a lot” higher. It also found that of the 1,117 people surveyed who had ACA marketplace coverage in 2025 (including those who dropped coverage or changed plans), about 55% said they are planning to deal with health care costs by cutting spending on food and other basic household needs.

The survey also documented heightened anxiety about medical bills. About three-quarters of people who had ACA insurance last year now say they are “very” or “somewhat” worried about paying for emergency care or hospitalization, while about half said they are similarly worried about routine medical visits or prescription drugs. KFF said the results show how unresolved political fights over ACA subsidies are continuing to affect people even as many lawmakers have turned to other priorities.

KFF’s results describe shifting coverage choices among people who were enrolled in the marketplace in 2025. The survey said that about 7 in 10 of those enrollees stayed on ACA coverage, including about 3 in 10 who changed plans within the marketplace. Another group—about 2 in 10—became eligible for coverage through their employer, Medicare or Medicaid, or bought insurance outside the ACA marketplace, which tends to offer less comprehensive benefits.

The survey also found that some people responded to premium increases by leaving coverage entirely. About 1 in 10 of last year’s enrollees said they dropped coverage and are now uninsured. One example described by the survey was Eric LeVasseur, a 63-year-old software developer in Seal Beach, California, who said that when he saw his mid-tier “silver-level” plan was set to nearly triple to $1,200 per month, “it was not something my budget could absorb.”

KFF reported that returning enrollees facing higher costs often direct blame at insurers and politicians. About 7 in 10 returning ACA enrollees who reported higher costs said they blame health insurance companies “a lot,” and just over half placed “a lot” of blame on Republican lawmakers, President Donald Trump and pharmaceutical companies. About one-third blamed Democrats in Congress or hospitals “a lot,” while about 1 in 10 placed this level of blame on doctors or employers.

The survey also included partisan perspectives on responsibility. It said that respondents who identified with a political party and saw costs rise overwhelmingly blamed the opposing party’s lawmakers “a lot.” One example was James Mako, an engineer in Boca Raton, Florida, who described being a political independent and said he blames the Republican Party. Mako said his $500-per-month premiums were set to double this year for his silver-level plan, and he said he downgraded to a bronze-level plan with a higher deductible, adding, “I think they’re just sales gimmicks,” and saying, “The subsidies should be back.”

KFF said the poll was conducted Feb. 12 to March 2, 2026, among 1,117 U.S. adults who had Marketplace insurance in 2025, using a sample drawn from two probability-based panels. KFF said all of the respondents participated in the 2025 KFF Marketplace Survey and were recontacted for the new survey. The poll’s margin of sampling error for the full sample was plus or minus 3.8 percentage points.