KFF Poll: ACA Premium Hikes Could Lead Many to Drop Coverage in 2026

A new KFF poll reveals that 25% of Americans covered by the Affordable Care Act (ACA) might forgo health insurance if their monthly premiums double in 2026, amid uncertainties about the expiration of enhanced premium tax credits. These tax credits currently help reduce costs for approximately 22 million people but are set to expire at the year's end, with congressional action pending. Open enrollment for ACA plans has started, and many individuals are already experiencing significant premium increases, leading to reconsideration of coverage options across marketplaces. The survey, conducted with 1,350 adults aged 18 to 64, indicates that one in three ACA enrollees would actively seek cheaper insurance plans if premiums doubled or if a no-premium plan shifted to a $50 monthly cost. Another concern is that 58% of enrollees cannot manage a $300 increase annually without damaging their household finances, and 20% would be disrupted by a $1,000 increase. These figures highlight the financial vulnerability among ACA enrollees regarding health insurance affordability. The data suggests potential growth in uninsured rates, reversing the ACA’s previous decline in uninsurance, which could have broader implications for public health and the insurance market. Respondents describe difficult choices, such as accepting higher out-of-pocket expenses to lower premiums or risking going uninsured altogether. The rising costs not only affect premium payments but also impact household finances, leading some to consider cutting spending on essentials or delaying bill payments. Individual cases shared in the survey underscore the challenges faced by families needing comprehensive coverage due to chronic health conditions. Increased premiums force some to evaluate coverage changes that could compromise access to care or to contemplate the unaffordability of crucial medications and treatments. This scenario presents critical considerations for policymakers and insurance providers regarding the future of ACA affordability and enrollment stability.