KFF Follow‑Up Survey Finds Many ACA Enrollees Plan to Cut Food and Basics or Drop Coverage After Enhanced Tax Credits Expire
A KFF follow‑up survey of 1,117 people with 2025 ACA marketplace coverage finds about eight in 10 returning enrollees say health care costs are higher this year (roughly half "a lot" higher), and 55% plan to cope by cutting spending on food and other basic household needs; roughly 7 in 10 stayed in ACA coverage, about 3 in 10 changed plans within the marketplace, 2 in 10 moved to employer/Medicare/Medicaid or off‑exchange coverage, and about 1 in 10 dropped coverage and are now uninsured. Respondents reported acute cost anxiety—around three‑quarters worry about paying for emergency care or hospitalization and about half worry about routine visits or prescriptions—a situation the survey links to Congress’s January 2026 failure to extend COVID‑era enhanced ACA subsidies, with some facing drastic premium shocks (one cited a mid‑tier plan nearly tripling to $1,200/month).
📌 Key Facts
- A KFF follow-up survey of 1,117 people who had ACA marketplace coverage in 2025 finds about 8 in 10 returning enrollees say their health care costs are higher this year, including roughly half who say costs are 'a lot' higher.
- About 55% of respondents say they plan to cope with higher health costs by cutting spending on food and other basic household needs.
- Enrollment shifts since last year: roughly 7 in 10 last‑year enrollees stayed in ACA marketplace coverage; about 3 in 10 changed plans within the marketplace; about 2 in 10 moved to employer coverage, Medicare/Medicaid, or off‑exchange plans; and about 1 in 10 dropped coverage and are now uninsured.
- Many enrollees report acute financial worry: around three‑quarters are very or somewhat worried about paying for emergency care or hospitalization, and about half are worried about affording routine visits or prescriptions.
- Reporting highlights specific price shocks — for example, a mid‑tier silver plan premium that would have nearly tripled to about $1,200 per month, which led an enrollee to go uninsured.
- The piece ties these impacts to Congress’s failure in January 2026 to reach a bipartisan compromise to extend COVID‑era enhanced ACA subsidies (enhanced tax credits) after Republicans blocked Democrats’ push for continuation.
📊 Relevant Data
The expiration of enhanced ACA premium tax credits is projected to increase the uninsured rate among Black non-Hispanic people from 9.7% to 11.9%, resulting in approximately 0.8 million more uninsured Black individuals, compared to a rise from 5.7% to 6.8% for White non-Hispanic people (2.0 million more uninsured) and from 17.9% to 19.8% for Hispanic people (1.0 million more uninsured).
The Impact of Enhanced Premium Tax Credits on Coverage by Race and Ethnicity — Urban Institute
Failing to extend enhanced ACA premium tax credits could lead to more than 200 preventable deaths among Black Americans each year nationwide, with metro areas like Atlanta (49 deaths) and Houston (48 deaths) seeing the highest numbers.
Failing to extend the enhanced ACA premium tax credits is an attack on working-class Black families and major metro areas — Economic Policy Institute
In 2024, food insecurity rates were 24.4% for Black non-Hispanic households (population ~13% of U.S.), 20.2% for Hispanic households (~19% of U.S.), and 10.1% for White non-Hispanic households (~58% of U.S.), with very low food security at 10.5%, 6.4%, and 4.1% respectively.
Household Food Security in the United States in 2024 — USDA Economic Research Service
Food-insecure families pay about 20% more annually in health care costs (average $2,500 extra) than food-secure families, with disparities persisting across insurance types: $1,855 more with public insurance, $2,107 more with private, and $3,531 more with no or mixed insurance.
Food Insecurity is caused by and leads to Higher Health Care Cost — Purchaser Business Group on Health
📰 Source Timeline (2)
Follow how coverage of this story developed over time
- The follow‑up KFF survey of 1,117 people who had ACA marketplace coverage in 2025 finds that about 8 in 10 returning enrollees say their health care costs are higher this year, including roughly half who say they are 'a lot' higher.
- About 55% of respondents say they plan to cope with higher health costs by cutting spending on food and other basic household needs.
- Roughly 7 in 10 last‑year enrollees stayed in ACA coverage, but about 3 in 10 of them changed plans within the marketplace; about 2 in 10 moved to employer, Medicare/Medicaid, or off‑exchange coverage; and about 1 in 10 dropped coverage entirely and are now uninsured.
- The article details specific price shocks, including a case where a mid‑tier silver plan premium would have nearly tripled to $1,200 per month, leading the enrollee to go uninsured.
- It highlights acute anxiety levels: around three‑quarters of respondents now say they are very or somewhat worried about paying for emergency care or hospitalization, and about half say the same regarding routine visits or prescriptions.
- The piece directly ties these outcomes to Congress’s failure in January 2026 to reach a bipartisan compromise to extend COVID‑era enhanced ACA subsidies after Republicans blocked Democrats’ push for continuation.