KFF

Costs, Coverage, and Enrollment Changes: Current Public Opinion and Policy on the ACA Marketplaces

The KFF panel examined the fallout from the expiration of enhanced ACA premium subsidies, focusing on how rising costs are reshaping enrollment, coverage continuity, and household budgets. 2025 marketplace enrollees faced an average 114% premium hike, and sign‑up data show roughly 23 million people were enrolled or automatically renewed—about one million fewer than the prior year. However, many have not yet paid premiums, leaving actual coverage numbers uncertain. A follow‑up survey of more than 1,300 original respondents (with 1,100 re‑interviewed) revealed that eight in ten now face higher health‑care expenses, half of whom cite sharply higher deductibles or co‑pays. Over half are cutting back on food and other essentials, and 55% say they are trimming basic household costs to afford health insurance. One‑in‑ten respondents have become uninsured, primarily citing the loss of subsidies, while 17% of those who remain on the marketplace doubt they can sustain premium payments through the year. Respondents highlighted concrete trade‑offs: many switched from silver to bronze plans to lower monthly premiums, accepting higher out‑of‑pocket risk. Direct quotes underscore the strain—one participant noted, “Without the subsidy I simply cannot afford the premium,” and another explained moving to a lower‑metal tier “to keep the bill manageable.” The data also show health‑care costs now rank above food, utilities, and housing as voters’ top economic worry. These trends are poised to re‑enter the political arena as midterm campaigns intensify, with health‑care affordability likely to dominate candidate messaging. Policymakers face pressure to address subsidy extensions or alternative relief, while insurers anticipate continued churn and potential increases in uninsured rates. The survey fills a critical data gap until official enrollment and uninsured statistics become available later in the year.