ACA Premium Hikes Threaten Coverage as Tax Credits Set to Expire

A new poll by the Kaiser Family Foundation (KFF) highlights significant concern among Affordable Care Act (ACA) enrollees regarding rising health insurance premiums for 2026. The poll reveals that one in four Americans covered by the ACA consider foregoing insurance if premiums double next year, reflecting apprehension over affordability as enhanced premium tax credits are set to expire. The survey sampled 1,350 adults aged 18 to 64 and found that many are reconsidering their coverage options amid premium increases across ACA marketplaces. About one-third of current ACA enrollees report they would actively seek cheaper plans if faced with a significant premium hike or new costs, while roughly 58% indicated they cannot absorb an annual premium increase of $300 without severe financial disruption. The findings underscore the financial strain on families with coverage, particularly those managing chronic illnesses or fixed incomes, who may face trade-offs between premium costs and out-of-pocket expenses like copays. Examples from survey respondents illustrate the hardship faced by policyholders. One family faced a premium increase from $2,000 to $2,500 per month, prompting consideration of plans with lower premiums but higher out-of-pocket costs. Another respondent, managing two chronic illnesses on a single income, emphasized the difficulty in affording both premiums and medical expenses, with an expected premium increase exacerbating budget constraints. The potential loss of enhanced premium tax credits beyond 2025 could lead to a rise in the uninsured population, reversing a decade-long trend of coverage expansion under the ACA. This poses regulatory and market challenges for insurers and policymakers striving to maintain coverage levels and affordability for millions of Americans. The survey also indicates that as total health care costs rise, many enrollees anticipate cutting household spending or delaying other bills, signaling broader economic implications beyond health insurance alone. Affordability remains a critical issue in the ACA marketplaces, with a majority of policyholders expecting above-average premium increases in 2026. As premium rates escalate, industry stakeholders, regulators, and legislators face pressure to assess the sustainability of current subsidy structures and the impact on insurance uptake and health outcomes. This environment underscores the need for ongoing analysis of payer/provider dynamics and consumer protections to mitigate coverage erosion.