Nearly 10% of people who had ACA Marketplace coverage in 2025 are now uninsured, according to a KFF poll.
The follow-up survey found healthcare costs were a major reason many enrollees either switched Marketplace plans or became uninsured. Indeed, 51% of returning enrollees said their healthcare costs are “a lot higher” than last year. Four in 10 specifically report much higher premiums.
And an overwhelming majority (80%) say their overall healthcare costs – including premiums, deductibles, co-pays, and coinsurance – have risen.
The survey of 1,117 Marketplace enrollees was conducted between February 12 and March 2, 2026, about a month after open enrollment ended in most states and before the grace period to make payments ends for many enrollees.
According to the survey, the increases stem from the expiration of enhanced premium tax credits in 2025, which had temporarily lowered monthly premiums for millions of Americans. It is a follow-up on a 2025 survey comprising 80% of the original sample group of ACA Marketplace enrollees.
Coping with costs
Marketplace enrollees are also concerned about their abilities to pay for both routine and unexpected medical expenses.
- 55% said they have already cut or plan to cut spending on food or other basic household needs. Among people with chronic conditions, that number rises to 62%;
- 73% worry about affording emergency care or hospitalizations; and
- nearly half are concerned about paying for routine visits (49%) or prescription drugs (45%).
KFF President and CEO Drew Altman said that these pressures may intensify as grace periods for premium payments expire. “The impacts on Marketplace enrollees we see in this follow-up survey will likely get worse as people struggle to make payments and the grace period many have expires,” Altman said.
Significantly, according to KFF researchers: “While most 2025 Marketplace enrollees say they still have Marketplace coverage in 2026, having insurance does not insulate them from worrying about the costs of accessing care.”
Indeed, the survey reveals that healthcare affordability is emerging as a major political issue:
- 70% of returning enrollees blame health insurance companies “a lot” for rising costs.
- At least half place significant blame on Congressional Republicans, President Trump, or pharmaceutical companies.
- 73% say healthcare costs will influence whether they vote in the midterms.
“Beyond being motivated to vote, some enrollees have taken actions to discuss their rising healthcare costs with friends and family, online, or by directly contacting an elected official,” the KFF researchers wrote.