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High costs, more uninsured without enhanced premium tax credits

A new KFF survey reveals significantly higher costs following the expiration of enhanced subsidies for Marketplace plans, with more enrollees dropping coverage this year.

Jacqueline LaPointe
By
Published: 19 Mar 2026

People with Affordable Care Act Marketplace plans are reporting significantly higher costs after Congress failed to extend enhanced premium tax credits, according to a survey from KFF.

KFF polled Marketplace enrollees late last year as lawmakers debated including an extension of enhanced premium tax credits in a government funding package. At the time, about 61% of respondents said deductibles and out-of-pocket costs under their Marketplace plans were already difficult to afford.

Enhanced premium tax credits, enacted during the COVID-19 pandemic, allow more Marketplace enrollees to access premium discounts. Most Marketplace enrollees, including nearly all Democrats and about 7 in 10 Republicans, favored extending the credits into 2026.

KFF repolled Marketplace enrollees about a month after open enrollment ended and following the expiration of the enhanced premium tax credits on Jan. 1. The survey showed that about half of respondents say costs are "a lot" higher now, with a total of 80% reporting higher healthcare costs in general.

The higher costs have about half of enrollees worried about affording even basic healthcare services, while nearly three-quarters of returning Marketplace enrollees say they are "very" or "somewhat" worried about being able to afford emergency care or hospitalizations. About 45% of respondents are concerned about paying for prescription drugs.

More Marketplace enrollees now uninsured

Higher healthcare costs following the expiration of enhanced premium tax credits led to more uninsured people.

The KFF survey found that about 9% of previous Marketplace enrollees participating in the first poll dropped coverage through the Affordable Care Act and are now uninsured. Another 28% of respondents said they changed Marketplace plans.

The majority of respondents who dropped or changed coverage cited costs, KFF reported.

Without enhanced premium tax credits, premium payments for Marketplace plans are expected to more than double what subsidized enrollees paid last year. Average premium payments will near $2,000 this year, up from a steady average of $888 in 2024 and 2025.

In the latest survey, about a third of Marketplace enrollees said they would very likely look for a different plan with a cheaper premium even if that plan had a higher deductible or co-pays if their insurance payments doubled. Another quarter of enrollees said they were very likely to go without insurance.

An Urban Institute analysis estimates 4.8 million people will lose coverage in 2026 without an extension of the enhanced premium tax credits.

Where enhanced premium tax credits stand

Congress may have let the enhanced premium tax credits expire, but they are not dead. Lawmakers continue to push for an extension, including a House bill passed on Jan. 8 that would push the credits for another three years.

The issue could play a big part in the midterm elections. The KFF survey found that three-quarters of Marketplace enrollees who are registered to vote said healthcare costs will affect their voting decisions. Nearly three-quarters also said healthcare costs will affect which party's candidate they will support.

At least half of enrollees placed blame on congressional Republicans (54%) and President Donald Trump (53%) for their increased healthcare costs, although 70% blamed insurance companies and 52% blamed pharmaceutical companies.

With many voters holding officials accountable for rising healthcare costs, the enhanced premium tax credits will be a key political battleground. Democrats have made the extension of these subsidies a cornerstone of their health policy in hopes of regaining control of Congress.

Democrats taking part in the KFF survey were more likely to say healthcare costs will impact their voting decisions. Although nearly half of independent voters said it will have a major impact on their decision to vote (47%) and on which candidate they choose (44%).

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.

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