One in ten 2025 ACA enrollees are now uninsured

One in ten 2025 ACA enrollees are now uninsured KFF survey shows the effect of the expiration of enhanced premium tax credits at the end of 2025.

Business Intelligence By Susan Morse , Executive Editor | March 20, 2026 | 11:09 AM Photo: Jose Luis Pelaez Inc./Getty Images A new KFF survey finds that one in 10 Affordable Care Act enrollees in 2025 are now uninsured. Half of those remaining in the ACA marketplace say their healthcare costs are “a lot higher” this year, according to the survey. Eighty percent of returning enrollees say their 2026 plan’s premiums, deductibles or coinsurance and co-pays are higher than last year.One in six, or 17%, of returning marketplace enrollees say they are not confident they will be able to afford their monthly health insurance premium for the entirety of 2026. A quarter of enrollees downgraded their plan’s metal tier from a Silver plan in 2025 to a Bronze plan to save money. The Bronze plans have lower premiums but higher out-of-pocket costs.ACA Marketplace enrollees worry about affording their monthly premiums, as well as out-of-pocket expenses such as emergency care or routine medical visits, according to the survey. Three in four (73%) returning marketplace enrollees say they are “very worried” or “somewhat worried” about being able to afford costs for emergency care or hospitalizations while about half are worried about affording costs for routine medical visits (49%) or prescription drugs (45%). A majority (55%) of returning enrollees say they are (or will be) cutting back spending on food or basic household items to afford the costs of coverage and care. The impact is greater for returning enrollees with chronic health conditions, with 62% saying they are, or will be, cutting back on food and other household items to help them afford their healthcare costs.The higher costs are due to the expiration of the enhanced premium tax credits at the end of 2025. Until then, the government paid insurers to keep premiums lower for ACA enrollees who qualified.A government shutdown ensued over bipartisan arguments over whether the government should subsidize insurers. President Trump said he supported giving the money directly to consumers. Trump unveiled the Great American Healthcare Plan that needs legislative approval.KFF conducted a probability-based survey of 1,350 adults covered by ACA marketplace plans in late 2025 and re-interviewed 1,117 individuals after the expiration of the enhanced premium tax credits. The report is based on all 2025 marketplace enrollees who took the follow-up survey. Topic: Accounting & Financial Management, Business Intelligence, Operations, Policy and Legislation, Reimbursement