What the New KFF Survey Reveals About Looming ACA Cost Challenges
Let me walk you through what’s going on with this new KFF survey, because it gives a really clear snapshot of how millions of people who buy their own health insurance are feeling right now—and the picture isn’t exactly calm.
So, the big issue here revolves around the enhanced premium tax credits that were first introduced during the pandemic under the American Rescue Plan Act. These boosted tax credits were designed to make health insurance more affordable for people buying coverage through the ACA Marketplace. They helped lower-income folks pay less and even opened the door for many middle-income families who previously didn’t qualify at all. These credits were later extended, but they’re now set to expire at the end of 2025. And if they’re not renewed, premiums could jump by an average of 114% for the 22 million people who currently rely on them. That’s not a typo—more than double.
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Because of that, KFF surveyed 1,350 Marketplace enrollees during the early weeks of the 2026 Open Enrollment period. The goal was to understand how people are reacting to the possibility of these credits ending and what it might mean for their wallets, their choices, and even their voting decisions heading into the 2026 elections.
A lot of people are already nervous. According to the survey, most enrollees say health insurance is extremely important for their peace of mind, their financial security, and their ability to access care. But cost pressures are intense. Six in ten say it’s tough to afford deductibles and out-of-pocket expenses, and half say even the monthly premiums are already difficult to manage. Many say that even a $300 increase in yearly health costs would seriously disrupt their household budget.
When asked what they’d do if their premiums doubled—which is the average projection if the tax credits vanish—the responses were pretty stark. About a third say they’d shop for a cheaper plan, even if it means higher deductibles. A quarter say they’d likely drop insurance entirely. And only about one in ten would simply stay with their current plan.
The survey also shows that these financial pressures are shaping political attitudes. More than 80% of enrollees, across the political spectrum, want Congress to extend the enhanced tax credits. And if they aren’t extended, many say they know exactly who they’d blame—mostly Republican leadership, including President Trump, according to the responses. These rising costs, if they materialize, could strongly influence how people vote in the 2026 midterms.
So overall, the survey paints a picture of a group of Americans who view health insurance as essential but increasingly at risk. Rising costs, policy uncertainty, and financial stress are combining to create a moment where real-world household budgets and political decisions are becoming tightly intertwined.
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