Rising ACA Premiums Threaten Coverage Amid Expiry of Tax Credits

A recent KFF poll highlights significant concerns among Affordable Care Act (ACA) enrollees about rising health insurance premiums for 2026. One in four Americans covered by the ACA are considering foregoing insurance if their monthly premiums double next year, amid ongoing uncertainty about the extension of enhanced premium tax credits which currently aid 22 million individuals. ACA open enrollment has revealed widespread premium increases, prompting many to reevaluate their coverage options as financial strain grows. The survey, conducted with 1,350 U.S. adults aged 18 to 64, found that one in three insured via the ACA marketplaces would likely seek cheaper plans if premiums increase substantially or if they face new premium payments where none existed before. This shift threatens to reverse the ACA’s success in reducing uninsured rates over the past decade. Experts underline that the decision to forgo coverage often reflects limited affordability rather than choice. Respondents shared the direct impact of premium hikes. One Florida family with chronic healthcare needs faces a nearly 25% premium increase, weighing options between higher monthly premiums or higher out-of-pocket costs. Such dilemmas highlight the complex trade-offs consumers face balancing coverage and affordability. The survey further indicated that 58% of enrollees could not absorb a $300 annual premium increase without disrupting household finances, and 20% would struggle with a $1,000 increase. Increased overall healthcare costs, including deductibles and copayments, exacerbate financial pressures. Approximately two-thirds of marketplace enrollees report they would need to cut basic household expenses or delay bill payments if costs rise by $1,000 next year. Many policyholders anticipate premium increases significantly above usual amounts, intensifying the affordability crisis. Personal stories underscore the challenges faced by individuals with chronic conditions, reliant on stable insurance coverage but squeezed by rising costs. For some, the prospect of doubled premiums could force uninsurance, with potential risks including delayed care and increased out-of-pocket expenses for essential treatments such as insulin. This trend poses important implications for the U.S. health insurance market, highlighting the critical role of policy decisions regarding subsidy extensions and regulatory measures to ensure coverage remains accessible. Insurers, policymakers, and healthcare stakeholders must consider the economic pressures facing ACA enrollees to address potential increases in the uninsured population and associated health disparities.