By Lina Irawan 
"Sometimes I don’t even take my medicine," Brown lamented, her voice tinged with frustration. "It’s so much with insurance, it’s crazy." Her struggle is not an isolated incident but a symptom of a broader healthcare affordability crisis gripping the nation, particularly exacerbated by the recent expiration of critical federal subsidies.
A recent survey from the health care research nonprofit KFF paints a grim picture: approximately 8 in 10 Americans, like Brown, who re-enrolled in Affordable Care Act (ACA) marketplace coverage report higher healthcare costs this year. Alarmingly, about half of these individuals describe their costs as "a lot" higher. The primary culprit for this sudden escalation in expenses was the December 31 expiration of enhanced tax credits, a vital component of the COVID-era relief efforts that had significantly offset health insurance premiums for most enrollees.
These enhanced subsidies, initially boosted under the American Rescue Plan and extended by the Inflation Reduction Act, were designed to make health insurance more accessible and affordable, particularly for low- and middle-income families. Their termination effectively reversed years of progress in reducing out-of-pocket costs, leaving an estimated 23 million ACA enrollees to face significantly higher premiums, deductibles, and medication costs. For many, this has meant making agonizing decisions to disenroll from coverage, downgrade to less comprehensive plans, or, like Brown, compromise their health.
The real-world impacts on daily life are profound and far-reaching. The KFF survey, which polled 1,117 Americans who had ACA marketplace coverage in 2025, revealed that about 55% are now planning to cut spending on food and other basic household needs to cope with their escalating healthcare expenses. This statistic underscores a terrifying reality: healthcare costs are not merely an abstract financial burden but a direct threat to food security and overall quality of life for millions.
The political battle to preserve these crucial subsidies raged in Congress last year, with Democrats advocating for their continuation, citing their proven effectiveness in lowering costs and expanding coverage. However, these efforts met significant resistance from Republican leadership, who largely favored market-based solutions and criticized the subsidies as government overreach. Despite initial hopes for a bipartisan compromise in January, negotiations ultimately collapsed, leaving ACA enrollees in a precarious position as federal lawmakers, at least for the moment, shifted their focus to other legislative priorities.
The KFF poll, conducted between February and March and following up with respondents from a similar survey last year, offers a critical glimpse into how this unresolved political fight continues to strain the lives of regular Americans. It highlights the direct correlation between policy decisions in Washington and the everyday struggles faced by families across the country.
Many ACA Enrollees Are Anxious About Medical Costs
Priscilla Brown’s personal financial burden has seen a dramatic shift. Last year, thanks to the enhanced subsidies, she paid nothing toward her health insurance premiums. This year, her new plan costs her $17 a month, a seemingly modest sum that masks a significantly higher deductible and increased out-of-pocket expenses for prescriptions. Brown recounted a recent shock: learning that a refill of her insulin was going to cost more than $150. She described feeling like she "almost passed out." In a desperate attempt to cover the cost, she filled her car with only half the gas she needed, knowing the remaining funds would be essential for her life-sustaining medication.
The KFF poll validates these anxieties, showing a widespread fear of unexpected medical bills. Approximately three-quarters of individuals who held ACA insurance last year now express being "very" or "somewhat" worried about their ability to pay for emergency care or hospitalization. Furthermore, about half of respondents shared similar concerns regarding routine medical visits or prescription drugs. These fears are well-founded, as inconsistent management of chronic conditions like Type 2 diabetes can lead to severe complications, including nerve damage, kidney disease, blindness, heart disease, and even limb amputations, all of which entail exorbitant medical costs.
Some Enrollees Switch to Lower-Tier Plans, While Others Drop Coverage Entirely
The expiration of the enhanced subsidies has forced a significant restructuring of healthcare coverage for many. While about 7 in 10 of last year’s ACA enrollees managed to stay on marketplace plans, nearly 3 in 10 of those had to switch to different plans within the marketplace, often opting for lower-tier options with higher deductibles and less comprehensive benefits to keep premiums manageable. Another 2 in 10 found alternative coverage through employers, Medicare, or Medicaid, or by purchasing insurance outside the ACA marketplace, which typically offers less robust protection.
Most concerning, however, is the statistic that about 1 in 10 of last year’s enrollees have dropped coverage altogether and are now uninsured. This group includes individuals like Eric LeVasseur, a 63-year-old software developer from Seal Beach, California. LeVasseur recounted the shock of seeing his mid-tier, silver-level plan premium nearly triple to an unaffordable $1,200 per month. "It was not something my budget could absorb," he stated, explaining his difficult decision to forgo insurance entirely. For individuals like LeVasseur, being uninsured means facing the full cost of any medical emergency or chronic condition, potentially leading to medical debt, bankruptcy, or, worse, delayed or foregone care with severe health consequences.
Many Enrollees Blame Health Insurance Companies and Politicians
The public’s frustration with the rising costs is palpable, and they are not shy about assigning blame. The KFF survey found that approximately 7 in 10 returning ACA enrollees facing higher costs place "a lot" of blame on health insurance companies. This sentiment reflects a long-standing public distrust of the insurance industry, often perceived as prioritizing profits over patient well-being.
Beyond insurers, political figures and pharmaceutical companies also bear a significant share of the public’s ire. Just over half of respondents assigned "a lot" of blame to Republican lawmakers, former President Donald Trump, and pharmaceutical companies. The pharmaceutical industry, in particular, has long been criticized for the exorbitant prices of prescription drugs in the U.S., which often far exceed costs in other developed nations. Conversely, about one-third of respondents placed "a lot" of blame on Democrats in Congress or hospitals, while doctors and employers received this level of blame from about 1 in 10.
Unsurprisingly, political affiliations heavily influenced these perceptions. Respondents who identified with a specific political party and reported increased costs overwhelmingly blamed the opposing party’s lawmakers "a lot." This partisan division highlights the entrenched nature of the healthcare debate and the difficulty of finding common ground.
James Mako, an engineer in Boca Raton, Florida, and a self-identified political independent, squarely blames the Republican Party for the current predicament. Mako’s own silver-level ACA health plan premiums were poised to double this year, from $500 to $1,000 per month. To mitigate the financial blow, he downgraded to a bronze-level plan, accepting a higher deductible in exchange for a lower monthly premium. Mako expressed skepticism regarding Republican proposals to address healthcare costs, such as funneling money into health savings accounts (HSAs), which he dismissed as "just sales gimmicks." His solution is straightforward: "The subsidies should be back."
The KFF poll, meticulously conducted from February 12 to March 2, 2026, gathered responses from 1,117 U.S. adults who had Marketplace insurance in 2025. Utilizing a sample drawn from two probability-based panels, all respondents had previously participated in the 2025 KFF Marketplace Survey and were recontacted for this follow-up. With a margin of sampling error of plus or minus 3.8 percentage points for the full sample, the findings offer a robust and timely insight into the severe and immediate consequences of policy shifts on the lives of everyday Americans struggling to afford healthcare. As Congress turns its attention to other matters, the echoes of their unresolved fight continue to resonate in the impossible choices faced by individuals like Priscilla Brown, making it clear that for many, the healthcare crisis is far from over.