A new survey shows a spike in health care costs for Americans enrolled in Affordable Care Act (ACA) marketplace plans after enhanced tax credits expire.
And nearly one in 10 Americans who enrolled in ACA plans last year dropped their coverage in 2026, according to a new AFF survey that highlights the growing impact of rising health care costs.
About 51% of returning students said their health care costs are “much higher” this year compared to 2025, including four in 10 who reported significantly higher premiums. Overall, 80% of respondents said their health care spending — covering premiums, deductibles, co-payments and co-insurance — has increased.
Costs rise after the tax credit expires
The findings come after enhanced tax credits that helped lower monthly insurance premiums for about 22 million Americans expire at the end of 2025. Congress did not extend these subsidies.
Concerns about affordability are deepening
The survey found that 17% of returning students are not sure they will be able to afford their premiums this year. For those who kept the same plans, the expiration of the extended tax credits more than doubled annual premium payments on average.
Household cutting essentials
Rising health care costs are forcing difficult financial trade-offs. Among those who re-registered:
-55% said they have reduced or plan to reduce spending on food or basic household needs
– This number increases to 62% for people with chronic health problems
Widespread anxiety about medical bills
Affordability concerns are still high:
-73% worry about emergency care or hospital costs
-49% are worried about common medical expenses
-45% are worried about being able to afford prescription drugs
Changes in coverage caused by costs
The survey found that 9% of Marketplace enrollees are now uninsured, while 69% have re-enrolled in ACA plans. Among those who remained:
Meanwhile, 22% opted for alternative coverage, including employer-sponsored insurance, Medicare, Medicaid, or non-Marketplace plans.
– Employer-based insurance (5%)
– Non-marketplace plans (5%), often with fewer protections
Political guilt before the midterm period
Among those facing higher costs:
-70% blame health insurance companies “a lot”
-54% blame Republicans in Congress
-52% blame pharmaceutical companies
Independents were more likely to attribute significant blame to Republicans and Trump than to Democrats.
Survey methodology
The survey, conducted from February 12 to March 2, 2026, included 1,117 US adults who had ACA Marketplace coverage in 2025. It was conducted online and by phone in English and Spanish with a margin of error of ±4 percentage points.
The findings underscore the growing financial strain on ACA enrollees following the elimination of pandemic-era subsidies, with rising premiums forcing households to cut back on essential spending and reshape coverage decisions ahead of the U.S. midterm elections.
Read also | US-Israel-Iran conflict: European firms pay for chips
