1 in 4 ACA enrollees may go without insurance if subsidies end

Modern Healthcare – Friday, December 5, 2025
By Diane Eastabrook

Millions of Americans who buy health insurance on the marketplace might forego coverage next year if the federal government ends COVID-era subsidies, according to a new poll.

More than 1,300 people who purchase health insurance on the Affordable Care Act exchanges want Congress to extend the enhanced tax credits set to expire at the end of the month, according to a survey conducted by health policy research organization KFF.There is some momentum on Capitol Hill for a short-term extension of the enhanced subsidies on health plans that approximately 22 million Americans get. KFF estimates premiums will increase about 114% if the enhanced subsidies expire.

The tax credits were extended as part of the 2022 Inflation Reduction Act. They increased financial assistance available to existing marketplace enrollees who already qualified for financial help and extended assistance to some middle-income adults who were not previously eligible for premium tax credits.

Here are five things to know about the survey’s findings:

Most enrollees expect higher insurance costs

More than half of survey respondents said they expected their health insurance to increase a lot in the next year. Just over a quarter said they expected a little more of an increase in premiums, while one in five polled said they thought their premiums would increase about the same as usual or not at all.

Enrollees are weighing their options

A quarter of respondents said if their monthly health insurance costs doubled next year — or increased $50 a month for those who pay no premium —they would go without insurance. About half said would likely look for a marketplace plan with lower premiums and higher deductibles and co-pays.

A smaller percentage said they would change jobs to get health insurance that meets their needs.

Most could not shoulder a big premium hike

About two-thirds of respondents said an annual premium increase of $300 would put a significant dent in their household finances. Younger consumers said they would be hit hardest by an increase in health insurance costs.

Many enrollees are struggling financially

About two-thirds of those polled said they already are struggling to pay out-of-pocket costs for medical care, such as deductibles and co-pays. About half said they also struggle to pay health insurance premiums, rent, mortgages, food and utility costs.

Many are educating themselves about options

More than half of those polled said they’ve sought out information about health insurance coverage for 2026 or had received information about the cost of plans.

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