If the amount they pay in premiums doubled, about 1 in 3 enrollees in Affordable Care Act Marketplace health plans say they would “very likely” look for a lower-premium Marketplace plan — one with higher deductibles and co-pays. What’s more, 1 in 4 would “very likely” go without insurance next year. This news comes from a recent survey of Marketplace enrollees conducted in early November by the health policy organization KFF.
The survey captures the views and experiences of 1,350 Marketplace enrollees between the ages of 18 and 64 as they weigh their coverage options for 2026, without the enhanced ACA credits or other policy changes that the U.S. Senate could debate this month. About 22 million of the 24 million Marketplace enrollees have benefited from the expiring tax credits, and without them, their premium payments are expected to rise an average of 114%, from $888 to $1,904 annually, according to KFF research.
In 2021, during the COVID-19 pandemic, Congress passed the American Rescue Plan Act, which temporarily increased tax credits available for adults purchasing their own health insurance through the ACA Marketplace. The enhanced tax credits increased the financial assistance available to existing Marketplace enrollees who already qualified for financial help and extended financial assistance to some middle-income adults who were previously not eligible for premium tax credits. The tax credits were extended as part of the 2022 Inflation Reduction Act and are set to expire at the end of 2025.
“The poll shows the range of problems Marketplace enrollees will face if the enhanced tax credits are not extended in some form, and those problems will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences,” KFF President and CEO Drew Altman said in a statement.
Here are five other findings of KFF’s survey:
- Nearly 6 in 10 enrollees (58%) say they would not be able to afford an increase of just $300 per year in the amount they pay for insurance without significantly disrupting their household finances. An additional 1 in 5 say they would not be able to afford a $1,000 per year increase in the amount they pay for health insurance without disrupting their finances.
- If their total health care costs — including premiums, deductibles, and other cost-sharing — increased by $1,000 next year,most Marketplace enrollees (67%) say they would likely cut spending on daily household needs, about half (54%) say they would likely to try to find another job or work extra hours, and 4 in 10 (41%) say they would likely skip or delay paying other bills. About one-third (34%) say they would take out a loan or increase their credit card debt.
- Additionally, about half of Marketplace enrollees say a $1,000 or more increase in total health care costs would have a “major impact” on their decision to vote in the 2026 midterm elections (54%) or on which party’s candidate they will support (52%). People with Marketplace insurance are more likely to say that either President Trump (37%) or Congressional Republicans (33%) would deserve most of the blame than they are to say Congressional Democrats (29%).
- About 4 in 10 Marketplace enrollees (39%) are Republicans or Republican-leaning independents, including about 1 in 4 (24%) who identify with President Trump’s Make America Great Again (MAGA) movement. Similarly, just over 4 in 10 enrollees (45%) identify as Democrats or Democratic-leaning independents, while 17% don’t identify or lean toward either party.
- More than half of Marketplace enrollees (54%) say they expect the cost of their health insurance coverage for next year will “increase a lot more than usual.”
Open enrollment for Marketplace coverage began Nov. 1 and runs through Jan. 15 in most states, though consumers must enroll in a plan by Dec. 15 if they want their coverage to begin on Jan. 1. The vast majority of enrollees (89%) expect to make a decision by the end of this year, with many saying they have already made their decision about coverage for next year.
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