A new KFF poll delivers a striking finding: 9% of Americans who held ACA Marketplace coverage in 2025 are now uninsured. Healthcare costs — not changes in health status — drove most of these coverage losses. The survey also reveals that those who stayed enrolled are now paying significantly more. Together, these findings paint a difficult picture for millions of Americans navigating a post-subsidy landscape.
Overview: What the KFF Poll Reveals
The KFF follow-up survey ran from February 12 to March 2 and included 1,117 U.S. adults who carried Marketplace insurance in 2025. Researchers drew the sample entirely from participants in KFF’s original 2025 Marketplace survey, which covered 1,350 adults. More than 80% of the original group participated in the follow-up.
The original survey launched amid intense debates over the expiration of enhanced premium tax credits. Its goal was to measure concern about rising coverage costs. The follow-up study then re-examined those same enrollees after the enhanced credits expired at the end of 2025 — specifically to track how they responded to higher costs.
Who Lost Coverage After 2025?
One in Ten Marketplace Enrollees Are Now Uninsured
Roughly one in 10 adults who held ACA Marketplace plans in 2025 no longer has insurance. Additionally, 28% switched to a different Marketplace plan for 2026. Notably, cost concerns drove more coverage changes than shifts in health needs. This distinction is important: people are not losing coverage because their health situation improved. Instead, they are losing it because the price became unmanageable.
Rising Costs Hit Re-Enrollees Hard
Premiums, Deductibles, and Copays All Climbed
Among adults who re-enrolled in ACA Marketplace coverage for 2026, the financial pressure is acute. More than half — 51% — report their healthcare costs are “a lot higher” this year. Furthermore, eight in 10 returning enrollees say their premiums, deductibles, or coinsurance and copays are higher in 2026 than they were in 2025. These increases cut across every cost-sharing category, leaving enrollees with fewer affordable options even after they chose to stay covered.
Affordability Fears Are Now Widespread
Emergency Care and Routine Visits Cause Concern
Financial anxiety among re-enrolled Americans extends well beyond premium notices. Three in four returning enrollees say they are very or somewhat worried about affording emergency care or hospitalization. Nearly half — 49% — are concerned about covering the cost of routine medical visits. Close behind, 45% worry about being able to pay for prescription drugs. These are not marginal fears. They reflect a broad erosion of confidence in healthcare affordability among people who are still technically insured.
Sacrificing Necessities to Stay Covered
Chronic Condition Patients Face the Steepest Trade-Offs
The financial strain goes beyond healthcare spending. More than half of returning enrollees say they are cutting back — or plan to cut back — on food and basic household items to afford their coverage and care. Among enrollees managing chronic health conditions, the figure climbs even higher: 62% report reducing or planning to reduce spending on daily necessities. These trade-offs signal that, for a large share of ACA participants, staying covered now competes directly with meeting basic living expenses.
Re-Enrollment Trends for 2026
Most Stayed — But Many Switched Plans
Despite widespread cost increases, most 2025 ACA enrollees chose to maintain Marketplace coverage. Nearly 7 in 10 re-enrolled for 2026. Within that group, 39% stuck with the same plan, while 28% moved to a different Marketplace option — likely searching for lower premiums or better coverage terms. Still, the 9% who became uninsured represent a meaningful portion of the enrolled population, particularly given that cost — not choice — drove their departure.
What This Means for ACA’s Future
The KFF findings arrive at a critical moment for U.S. health policy. The expiration of enhanced premium tax credits has accelerated a shift that many policy experts warned about: when subsidies shrink, coverage rates follow. For policymakers, insurers, and healthcare advocates, the data raises urgent questions about how to make Marketplace plans financially sustainable for low- and middle-income enrollees.
Moreover, the pattern of cutting back on food and essentials to maintain coverage points to a structural affordability problem — one that premium design alone cannot fix. Broader legislative action or renewed subsidy support may be necessary to prevent further coverage erosion in 2027 and beyond.
