KFF Survey and NPR Profiles Show ACA Enrollees Cutting Food and Dropping Coverage After Enhanced Tax Credits Expire
A KFF follow‑up survey of 1,117 2025 ACA marketplace enrollees finds about 8 in 10 say their health care costs are higher this year (roughly half "a lot" higher), about 55% plan to cut spending on food and other basics, roughly 7 in 10 remained in marketplace coverage while about 1 in 10 dropped coverage entirely and became uninsured, and large shares report worry about affording emergency and routine care. NPR profiles put human faces on those numbers — including a Connecticut couple whose premium jumped from ~$630 to $2,531 monthly and who drained retirement savings — underscoring that many enrollees are taking extra work, loans or cutting essentials after Congress failed in January 2026 to extend COVID‑era enhanced ACA subsidies.
📌 Key Facts
- A follow-up KFF 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 in 2026, 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; many enrollees are also taking extra jobs, working more hours, or using loans and credit‑card debt to pay for care.
- Roughly 7 in 10 last‑year enrollees stayed in ACA coverage for 2026, but around 3 in 10 of those 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 entirely and are now uninsured.
- Around three‑quarters of respondents say they are very or somewhat worried about paying for emergency care or hospitalization, and about half express similar worry about routine visits or prescription drugs.
- Reporting documents sharp premium spikes and personal price shocks: one mid‑tier silver plan premium nearly tripled to about $1,200 per month, prompting an enrollee to go uninsured; NPR profiles a Connecticut self‑employed couple whose premium for two adults rose from about $630/month in 2025 (plus ~$100 dental) to $2,531.07/month in 2026, and who had already drained a small retirement account to cover 2025 medical and home‑repair costs.
- The reporting directly ties these outcomes to Congress’s failure in January 2026 to reach a bipartisan compromise to extend the COVID‑era enhanced ACA subsidies after Republicans blocked Democrats’ push to continue them.
📊 Relevant Data
In 2024, Black individuals accounted for 16.3% of ACA marketplace plan selections, compared to their approximately 13% share of the U.S. population, while Hispanic individuals accounted for 29.4%, compared to their approximately 19% share.
HealthCare.gov Plan Selections by Race and Ethnicity, 2015-2024 — Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services
The self-employment rate for Black workers in the US is 4.2%, less than half the national average of approximately 10%.
Measuring the headwinds to Black self-employment — Economics Letters (via ScienceDirect)
In 2023, the self-employment rate for Hispanic workers was 10.0%, compared to 9.6% for non-Hispanic workers, with foreign-born Hispanic workers at 14.1%.
Trends in Self-Employment Among Hispanic Workers — U.S. Census Bureau
Racial disparities in food insecurity persist across the US even after accounting for income levels, with higher rates among Black and Hispanic households at both high- and low-income brackets from 2000 to 2023.
Food Insecurity Defined by Racial Disparities Across the Country — The American Journal of Managed Care (AJMC)
📰 Source Timeline (3)
Follow how coverage of this story developed over time
- Profiles a self‑employed Connecticut couple whose ACA premium for two adults jumped from about $630 per month in 2025 (plus ~$100 dental) to $2,531.07 per month in 2026 after enhanced subsidies expired, roughly equal to an average U.S. mortgage payment.
- Details that this couple already drained one of their small retirement accounts to cover 2025 out‑of‑pocket medical and home‑repair costs, underscoring how little financial cushion many mid‑income self‑employed households have as premiums spike.
- Reinforces and gives narrative context to KFF’s finding that more than half of ACA enrollees are cutting back on household spending — including groceries — and that some are taking extra jobs, working more hours, or taking on loans and credit‑card debt to pay for health care.
- 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.