Most people who get their health coverage through the Affordable Care Act say they face sharply higher costs, with many worried they will have to pare back other expenses to cover them, according to a . Some are uncertain whether they will be able to continue paying their premiums all year.
Still, 69% of those enrolled last year signed up again this year, often for less generous coverage. About 9% said they had to forgo insurance, according to the survey by 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.
The 麻豆女优 poll revisited the people who responded to of Affordable Care Act enrollees during open enrollment for ACA plans.
Steve Davis, a 64-year-old retired car salesman in Rogersville, Tennessee, who participated in both polls, said he was looking at an annual premium of about $14,000 to renew his ACA coverage this year. He didn鈥檛 qualify for enough of a tax credit to defray the cost, he said, after Congress gridlocked on an extension of more-generous subsidies put in place under President Joe Biden.
But things worked out for Davis. He landed a job at a convenience store that came with insurance, with his share costing about $100 more a month than the $300 he paid for an ACA plan last year, before the enhanced tax credits expired.
鈥淎s it happened, the Lord provided and my insurance kicked in through my employer,鈥 he told 麻豆女优 Health News.
In the November survey, many respondents were not sure what they would do for their health insurance in the coming year.
Some were waiting to see whether Congress would extend the enhanced premium subsidies, which had helped many people get lower-cost 鈥 or even zero-cost 鈥 health premiums.
Congress鈥 inaction left some consumers in a bind.
Now, the new poll found, affordability issues are hitting home as the midterm election approaches. And that might play a role in competitive districts, creating headwinds for Republicans.
Midterm Signals
Across all respondents who were registered to vote, the poll found more than half place 鈥渁 lot鈥 of blame for rising costs on Republicans in Congress (54%), with a similar share putting the same level of blame on President Donald Trump (53%). A smaller group placed a lot of the blame on congressional Democrats (34%). Among independents, a group expected to be a key factor in many districts, the percentages putting a lot of the blame on the GOP (56%) and Trump (58%) were higher.
Among Republicans, 60% placed a lot of the blame on Democrats in Congress.
鈥淭hose who have marketplace coverage, who remained on it, they鈥檙e really struggling with health care costs,鈥 said Lunna Lopes, senior survey manager for 麻豆女优.
While more than half (55%) of returning ACA enrollees said they will have to pare back on other household expenses to cover health care costs, about 17% said they might not be able to continue paying insurance premiums throughout the year.
Overall, 80% of those who reenrolled for 2026 said their premiums, deductibles, or other costs are higher this year than last, with 51% saying they are 鈥渁 lot higher.鈥
About three-quarters of ACA enrollees in the survey who were registered voters said the cost of health care will have an impact on their decision to vote 鈥 and on which party鈥檚 candidate they support.
Democrats were more than twice as likely as Republicans to say those costs will have a major impact on their decision.
鈥淒emocrats seem particularly more energized by health care costs than their Republican counterparts,鈥 Lopes said.
Enrollment Tally Down
Data released Jan. 28 by federal officials showed that about 23 million people enrolled in Obamacare plans across the federal healthcare.gov marketplace and those run by states, about 1.2 million fewer than in 2025.
But it isn鈥檛 yet known how many are paying their monthly premiums on time, and many analysts expect overall enrollment numbers to fall as that data becomes available in the coming months.
For most people, having to pay more for premiums this year was mainly due to the expiration of the enhanced tax cuts, pollsters noted. Because the subsidies that remain are less generous, households have to pay more of their income toward coverage. Congressional inaction also meant the restoration of an income cap for subsidies at four times the poverty level, or $62,600 for an individual, sticking people like Davis with higher bills.
Not everyone saw increases.
Matthew Rutledge, a 32-year-old substitute teacher in Apple Valley, California, who participated in both 麻豆女优 polls, said he qualified as low-income and his subsidies fully offset his monthly premium payment, just as they did last year. He does have copayments when he sees a doctor or accesses other medical care, but he told 麻豆女优 Health News that 鈥渁s long as the premium doesn鈥檛 go up, I鈥檓 fine with it.鈥
Rising premiums are fueled by a variety of factors, including hospital costs, doctors鈥 services, and the prices of drugs.
To lower premiums, insurers offer plans with higher deductibles or copayments. In the ACA, plans with lower premiums but higher deductibles are called 鈥渃atastrophic鈥 or 鈥渂ronze鈥 plans. 鈥淪ilver鈥 plans generally balance premiums and out-of-pocket spending, while the highest-premium plans with lower deductibles are 鈥済old鈥 or 鈥減latinum.鈥
About 28% of those who stayed in the ACA marketplaces switched plans, the pollsters noted.
One 56-year-old Texas man told pollsters that his family鈥檚 income exceeded the cap for subsidies, so they switched down from a gold plan to a bronze. 鈥淓ven doing that, our premiums are three times what they were in 2025, with lower plan features and a higher deductible,鈥 he said, according to a 麻豆女优 poll news release.
For some, reenrolling was not a viable option.
In addition to the 9% who said they are now uninsured, about 5% said they switched to some type of non-ACA coverage.
Some people, like Davis, landed job-based coverage, while others found they qualified for Medicaid, the joint state-federal program for low-income residents.
Such churn in and out of ACA coverage is not unusual, Lopes noted. 鈥淧eople get a job. They get married. They age into Medicare,鈥 the program for older or disabled people, she said.
The poll highlighted that many people dropping coverage were younger, between 18 and 29. About 14% of people in that range now say they are uninsured.
That鈥檚 not surprising, given that younger people tend to use health coverage less. ACA insurers said one reason they raised premiums this year was because they expected more young or healthy people to drop out, leaving them with a higher share of older, more costly enrollees. Among those 50 or older, the poll found that only 7% are now uninsured.
GOP critics of the now-expired enhanced subsidies say they were always meant to be temporary. Extending them would have cost about $350 billion from 2026 to 2035, .
But not extending them means more people will become uninsured. The CBO said the extension would have meant 3.8 million more people having insurance coverage in 2035.
麻豆女优 pollsters, in February and early March, surveyed 1,117 U.S. adults, more than 80% of the ACA enrollees originally polled in November, online and by telephone. The margin of error is plus or minus four percentage points for the full sample.
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