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KFF Poll: 9% of ACA Enrollees Uninsured After Subsidy Expiration

A KFF survey of over 1,100 ACA enrollees finds that 9% lost insurance after enhanced subsidies expired in 2026, causing premiums to more than double. Many faced financial strain, with 17% uncertain about affording coverage, and some downgraded to cheaper plans. Politically, most enrollees blame Republicans and President Trump for cost hikes, potentially swaying midterm elections. Enrollment is projected to fall by half by 2028 due to policy changes, highlighting the subsidies' critical role in maintaining coverage.

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KFF Poll: 9% of ACA Enrollees Uninsured After Subsidy Expiration

A recent KFF survey reveals that 9% of Americans enrolled in Affordable Care Act marketplace health plans in 2025 are now uninsured after enhanced federal subsidies expired, causing premiums to more than double and straining household finances.

Survey Methodology and Key Findings

  • The nonpartisan KFF survey polled 1,117 U.S. adults who had ACA marketplace coverage in 2025, conducted from February 12 to March 2, 2026.
  • Over 90% of ACA enrollees (approximately 22 million people) received enhanced subsidies in 2025, which lowered monthly premiums.
  • With the subsidies' expiration, average premiums more than doubled for enrollees in 2026.

Impact on Insurance Coverage and Finances

  • 9% of 2025 enrollees reported losing their health insurance entirely due to higher costs.
  • 17% of returning enrollees lack confidence in affording their 2026 premiums, risking further coverage loss.
  • Many households responded by downgrading plans or expressing significant worry about medical expenses if they become ill.
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Plan Changes and Consumer Choices

  • 28% of respondents kept ACA coverage but switched to a different plan, often opting for lower-premium bronze-tier options.
  • Bronze plans typically have cheaper monthly costs but higher out-of-pocket expenses when care is used, according to health policy experts.
  • ACA plans are structured into metal levels: Platinum, Gold, Silver, and Bronze, with varying cost-sharing designs.

Political Ramifications and Voter Blame

  • Health-care affordability is poised to influence the November 2026 midterm elections, analysts note.
  • The KFF poll shows 54% of returning enrollees blame congressional Republicans "a lot" for rising costs, and 53% blame President Donald Trump.
  • Independents are more likely to assign high blame to Republicans (56%) and Trump (58%) than to congressional Democrats (28%).
  • The subsidy expiration was central to a prolonged government shutdown, with Democrats advocating for extension and Republicans opposing.

Future Enrollment Projections

  • The Congressional Budget Office forecasts ACA marketplace enrollment to drop to 12.5 million by 2028, roughly half of 2025 levels.
  • This decline is linked to the subsidy lapse and administrative changes, such as those in the GOP's legislative package, that complicate enrollment and retention.
  • The projected reduction threatens to reverse coverage gains achieved since enhanced subsidies began in 2021.
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