KFF Survey: ACA Marketplace Enrollees Face Premium Hikes Amid Expiring COVID-era Subsidies

A recent survey by the Kaiser Family Foundation (KFF) highlights growing concerns among Affordable Care Act (ACA) marketplace enrollees over rising health insurance premiums and the expiration of COVID-era enhanced premium tax credits at the end of 2024. Many enrollees currently face high monthly premiums, with some paying close to $900 per month, and anticipate increases averaging around $200 monthly once the subsidies expire. This expected rise could significantly impact households already struggling with out-of-pocket medical costs such as deductibles and copays. The enhanced premium tax credits have been crucial in making health insurance affordable for more than 90% of ACA marketplace enrollees. However, legislative gridlock has put these credits at risk, with no clear resolution as the enrollment period for 2025 health plans proceeds. Congressional negotiations have stalled, reflecting partisan disagreements about whether to extend, reform, or discontinue the subsidies. Survey data reveals that over 60% of marketplace enrollees find it financially challenging to manage out-of-pocket medical expenses. A majority also report that even a $300 increase in their annual premiums would cause significant financial hardship, underscoring the vulnerability of lower-income enrollees who rely heavily on these subsidies. The ACA enrollee population includes a range of income levels, but predominantly features lower-income individuals and families living paycheck to paycheck, making any premium increase a potential source of financial strain. For some higher earners with health issues, despite the financial burden, maintaining their current plans remains a necessity to avoid gaps in coverage. More than half of surveyed enrollees expect their insurance costs to increase substantially next year, and many feel that without an extension of premium tax credits, the affordability of healthcare will worsen. This sentiment is consistent regardless of political affiliation, with significant majorities across Democrats, independents, and Republicans supporting the continuation of the tax credits. Political opinions among enrollees show a tendency to hold Republican lawmakers and former President Trump more accountable than Democrats for the potential expiration of the subsidies. Nevertheless, there is a shared hope among some for bipartisan compromise to secure at least a temporary extension of the credits to mitigate market disruption. The anticipated premium increases and the expiry of subsidies raise concerns about access to affordable healthcare coverage and financial stability among millions of Americans enrolled in ACA marketplace plans. The unresolved status of the tax credit extensions threatens to exacerbate the challenges faced by these consumers amidst broader inflationary pressures on healthcare costs. The situation underscores the critical dependency of marketplace enrollees on federal subsidies and highlights the potential consequences of legislative inaction on the healthcare insurance market. Stakeholders in the insurance industry, including policymakers, payers, and providers, will be monitoring the evolving policy landscape closely as the enrollment period progresses and deadlines approach.