Nearly four in 10 Affordable Care Act enrollees either dropped coverage or switched plans in 2026, with rising costs pushing 9% into uninsured status and higher exit rates reported among younger enrollees.
A KFF follow-up survey of 1,117 individuals found that 37% of 2025 Marketplace enrollees no longer have the same coverage, including 9% who are now uninsured and 28% who switched plans. While 69% remain enrolled in Marketplace coverage, 39% kept the same plan and 28% selected a different one. Another 22% transitioned to other forms of coverage, including employer-sponsored insurance, Medicaid, Medicare, or non-Marketplace plans.
Younger enrollees report higher exit rates. Among those aged 18 to 29, 49% say they have left the Marketplace, including 14% who are uninsured. Among those aged 50 and older, 7% report being uninsured.
Costs remain the primary reason for coverage changes. Among those who switched plans or became uninsured, 80% say cost was a reason, including 71% who cite it as a major factor. Only 36% point to changes in healthcare needs.
The changes follow the expiration of enhanced premium tax credits at the end of 2025. Those subsidies had reduced premium costs for about 22 million Americans. Without them, average ACA premiums reached $1,904 in 2026, up from $888 in 2025. Enrollment declined to about 23 million from 24.2 million a year earlier.
Among those who retained coverage, 80% report higher healthcare costs, including premiums, deductibles, and other cost-sharing, with 51% saying costs are “a lot higher”. Sixty-three per cent (63%) report higher premiums, 45% report higher deductibles, and 36% report higher coinsurance or copayments.
Plan changes reflect these pressures. About 26% of those who switched plans moved to a lower metal tier, which typically carries lower premiums but higher out-of-pocket costs. Among those who switched, 54% report higher deductibles and 42% report higher coinsurance or copayments compared with the previous year.
Policy discussions are examining the role of higher-deductible plan options, including catastrophic coverage, in addressing premium costs.
Affordability concerns extend beyond premiums. Seventy-three per cent (73%) of enrollees report concern about paying for emergency care or hospitalizations, 49% for routine medical visits, and 45% for prescription drugs.
These cost pressures are affecting household finances. Fifty-five per cent (55%) say they are cutting or plan to cut spending on food or basic household items to cover health care costs. Forty-four per cent (44%) report difficulty affording other expenses such as food, utilities, rent or mortgage, and transportation. In addition, 43% say they are working more or seeking additional income, 23% report delaying bill payments, and 20% report taking on debt.
One in six (17%) say they are not confident they can afford their premiums for the full year, and 4% report they have not yet paid their first premium for 2026.
Separate reporting by KFF Health News describes some individuals choosing to forgo coverage and rely on payment arrangements or community health providers for care.
The expiration of enhanced subsidies has renewed debate over ACA affordability. President Donald Trump has criticized the law’s cost structure, while some Republican lawmakers attribute rising premiums to ACA coverage requirements, according to reporting by KFF Health News.
Democrats have argued that the removal of subsidies is driving current cost increases. Senate Majority Leader John Thune said in December that extending “a failed program that’s rife with fraud, waste and abuse is not happening.” Rep. Suzan DelBene said on New Year’s Day, “Make no mistake, the blame behind the skyrocketing health care costs millions are facing today is squarely at the feet of House Republicans, and the American people know it.”
Additional legislative proposals are under consideration. According to congressional disclosures, a bipartisan bill would increase the medical loss ratio requirement from 80% to 85%, requiring insurers to allocate a larger share of premiums to medical care.
Healthcare costs are influencing voter sentiment. The KFF survey found that 48% of Marketplace enrollees say costs will have a major impact on their voting decisions. Broader polling, reported by CNBC, indicates that 66% of Americans cite healthcare costs as a top financial concern, ahead of other household expenses.
Among enrollees experiencing higher costs, 70% place significant blame on health insurance companies, while 54% cite Congressional Republicans, 53% President Trump, and 52% pharmaceutical companies, according to survey findings reported in coverage of the KFF data.
The KFF follow-up survey was conducted from February 12 to March 2, 2026, among a nationally representative sample of adults who had Marketplace coverage in 2025, with a margin of error of ±4 percentage points.
