KFF Survey: 2026 ACA Premium Tax Credit Expiry Could Double Costs for 22M Enrollees

The American Rescue Plan Act (ARPA) temporarily boosted premium tax credits for adults purchasing insurance via the ACA Marketplace during the COVID-19 pandemic. These enhancements, extended by the Inflation Reduction Act, are poised to expire at the end of 2025, risking an average 114% premium increase for 22 million current tax credit recipients. The Kaiser Family Foundation (KFF) surveyed 1,350 Marketplace enrollees in November 2025 to explore their expectations and plans amid this impending change. Results reveal that over half of enrollees anticipate significant premium hikes in 2026, with 54% foreseeing a "lot more than usual" and an additional 26% expecting a slight increase. Those with incomes above 400% of the federal poverty level (FPL), who now benefit from the credits, face full-price premiums if credits lapse. Information seeking about 2026 insurance costs is slightly higher among enrollees in federally-facilitated Marketplace states than state-run ones. Despite current premium tax credits, many enrollees report financial difficulty with health care costs: 61% find out-of-pocket expenses challenging and 51% struggle with premium affordability. Health insurance remains a top priority, with 77% valuing it for access to care, and 78% for peace of mind. If tax credits expire, 90% expect increased monthly payments, with 69% anticipating a major impact. Most enrollees could not absorb a $300 to $1,000 annual increase without financial hardship, especially younger adults and low-income households. Potential reactions to doubled premiums include seeking cheaper plans (32%), going uninsured (25%), or changing jobs for coverage (15%). Finding alternative affordable insurance poses a challenge for 89% of enrollees. Increased costs are also expected to affect household budgets profoundly, with many likely to reduce spending on essentials, work additional hours, or take on debt. Political implications are evident: 84% support extending enhanced tax credits across party lines. However, confidence in Congress and political leaders to address insurance affordability remains low, with blame for potential credit expiration divided among parties. Marketplace enrollees are divided politically—roughly 39% identify Republican or Republican-leaning, including 24% MAGA supporters, and 45% Democrat or Democratic-leaning. Health care cost increases may influence voter behavior in the 2026 midterms, with about half of registered Marketplace enrollees reporting a major impact on their voting decisions and candidate support. Democratic voters are more inclined to say increased costs would affect their vote compared to Republicans and independents. This KFF survey used a nationally representative sample with methodological rigor, ensuring insights into the financial pressures facing ACA Marketplace enrollees and the broader ramifications for insurance markets and political dynamics as the enhanced premium tax credits face expiration.