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Americans Grapple with Rising Health Costs as ACA Subsidies Expire
Lately, Priscilla Brown has faced an impossible choice: properly managing her Type 2 diabetes or affording other necessities, like gas for her car. The 48-year-old truck dispatcher from Orlando, Florida often takes just half or a third of her prescribed insulin dose to make it last longer.
“Sometimes I don’t even take my medicine,” Brown admitted. “It’s so much with insurance, it’s crazy.”
Brown’s situation reflects a growing crisis among Americans enrolled in Affordable Care Act (ACA) marketplace coverage. According to a new survey by the health care research nonprofit KFF, about 80% of people who re-enrolled in ACA plans report higher health care costs this year, with roughly half saying their costs are “a lot” higher.
The primary culprit is the December 31 expiration of enhanced tax credits that had previously offset premiums for most enrollees. These COVID-era subsidies ended despite efforts by Democrats to extend them, leaving approximately 23 million ACA enrollees facing higher premiums and difficult financial decisions.
For many Americans, the increased costs are forcing painful trade-offs. Among the 1,117 ACA marketplace enrollees surveyed in February and March, about 55% said they’re planning to cut spending on food and other basic household needs to manage their health care expenses.
Brown’s experience illustrates this reality. Last year, she paid nothing for her health insurance premiums. This year, her new plan costs $17 monthly but comes with a higher deductible. When she recently learned a medication refill would cost over $150, she “almost passed out” and had to fill her car with only half the gas she needed to afford her medicine.
The survey reveals widespread anxiety about medical costs among ACA enrollees. Approximately three-quarters of respondents expressed worry about paying for emergency care or hospitalization, while about half reported similar concerns regarding routine medical visits or prescription medications.
Most of last year’s enrollees—about 70%—maintained some form of ACA coverage, though nearly a third switched to different plans within the marketplace. Meanwhile, roughly 20% transitioned to employer-sponsored insurance, Medicare, Medicaid, or non-ACA plans, which typically offer less comprehensive coverage.
Perhaps most concerning, about 10% of last year’s enrollees reported dropping coverage entirely, leaving them uninsured. Eric LeVasseur, a 63-year-old software developer from Seal Beach, California, was among those who couldn’t justify the expense after seeing his mid-tier silver plan nearly triple to $1,200 monthly. “It was not something my budget could absorb,” he explained.
When asked who deserves blame for rising costs, enrollees pointed fingers in multiple directions. About 70% of returning ACA enrollees facing higher costs blamed health insurance companies “a lot,” while just over half assigned significant blame to Republican lawmakers, former President Trump, and pharmaceutical companies. Roughly one-third blamed Congressional Democrats or hospitals heavily, with doctors and employers receiving less criticism.
Predictably, respondents who identified with a political party overwhelmingly blamed the opposing party’s lawmakers for the cost increases. James Mako, an engineer in Boca Raton, Florida, and a political independent, primarily faults Republicans. When his $500 monthly premium was set to double this year, he downgraded to a bronze-level plan with a higher deductible.
Mako expressed skepticism about Republican-proposed solutions like expanded health savings accounts. “I think they’re just sales gimmicks,” he said. “The subsidies should be back.”
The bipartisan compromise that seemed possible in early January ultimately collapsed, leaving millions of Americans without relief as they navigate higher premiums. Meanwhile, many federal lawmakers have shifted focus to other priorities, despite the ongoing financial strain on ACA enrollees.
The KFF poll, conducted from February 12 to March 2, 2026, included 1,117 adults who had Marketplace insurance in 2025. All respondents had participated in KFF’s 2025 Marketplace Survey and were recontacted for this follow-up research. The margin of sampling error for the full sample is plus or minus 3.8 percentage points.
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10 Comments
This is a concerning trend – people having to ration their medication or skip it entirely just to cover other essential costs. The ACA was meant to improve healthcare access and affordability, so letting these subsidies expire is counterproductive. I hope lawmakers can work together to find a solution that protects vulnerable patients.
Agreed. It’s heartbreaking to hear stories like Priscilla Brown’s, where managing a chronic condition becomes a constant struggle. We need to find ways to keep healthcare costs down and ensure no one has to make those kinds of impossible choices.
This is a real crisis that needs to be addressed. Forcing people to choose between managing their health and affording basic necessities is unconscionable. The ACA was supposed to make healthcare more affordable, so letting these subsidies lapse is a huge step backwards. I hope lawmakers can come together quickly to find a sustainable solution.
Agreed, this is an unacceptable situation. Healthcare should be a right, not a luxury. Policymakers need to act fast to restore that financial assistance and ensure no one has to make those kinds of painful trade-offs just to get the care they need.
The expiration of ACA subsidies is really putting a strain on many Americans who rely on this coverage. It’s concerning to hear stories like Priscilla Brown’s, where people are having to skip or reduce their prescribed medication doses just to afford basic necessities. This highlights the need for a long-term, sustainable solution to healthcare affordability.
I agree, the loss of those subsidies is really putting people in a tough spot. Lawmakers need to address this issue before more people are forced to make difficult choices about their healthcare.
The findings from this survey are really disheartening. It’s unacceptable that so many ACA enrollees are facing significantly higher costs, forcing them to make tough financial trade-offs. Policymakers need to address this issue urgently before more people lose access to the care they need.
Absolutely right. The ACA was meant to improve healthcare affordability, so letting these subsidies expire is a major setback. I hope we see a bipartisan effort to find a solution that protects vulnerable patients and keeps coverage accessible.
It’s disappointing to see the ACA subsidies expire, especially when they were helping to make healthcare more accessible for millions of Americans. I hope policymakers can find a way to restore or replace that financial assistance so people don’t have to sacrifice their wellbeing just to get by.
Absolutely. Affordable healthcare shouldn’t be a luxury, it’s a basic human need. Letting these subsidies lapse is a step in the wrong direction and will only exacerbate the challenges many families are already facing.