NEW YORK (AP) 鈥� Lately, Priscilla Brown has had to choose between properly managing her Type 2 diabetes and affording other necessities, like gas in her car. Some days, she takes half or a third of her prescribed insulin dose 鈥� just to stretch it out longer.
鈥淪ometimes I don鈥檛 even take my medicine,鈥� said the 48-year-old truck dispatcher in Orlando, Florida. 鈥淚t鈥檚 so much with insurance, it鈥檚 crazy.鈥�
About 8 in 10 Americans, like Brown, who re-enrolled in Affordable Care Act marketplace coverage say their health care costs are higher this year, including about half who say their costs are 鈥渁 lot鈥� higher, according to a new from the health care research nonprofit KFF. A main reason for increased costs was the Dec. 31 of enhanced tax credits that had offset premiums for most enrollees.
For Brown and others, those spiking costs are having . Of the 1,117 Americans surveyed who had ACA marketplace coverage in 2025, including those who dropped coverage or changed plans, about 55% said they鈥檙e planning to deal with health care costs by cutting spending on food and other basic household needs.
Democrats in Congress last year had fought to keep the COVID-era subsidies but faced pushback from Republican leadership. In January, momentum toward a bipartisan compromise 鈥� leaving some 23 million ACA enrollees without relief as they faced higher premiums or made tough decisions to disenroll or downgrade plans.
The new poll, which was conducted in February and March and followed up with respondents to learn how they’re grappling with health insurance now, offers a glimpse at how Congress’ unresolved fight continues to strain regular Americans 鈥� even as many federal lawmakers have, at least for the moment, turned to other priorities.
Many ACA enrollees are anxious about medical costs
Last year, Brown paid zero dollars toward her health insurance premiums. This year, her new plan costs $17 a month 鈥� and has a higher deductible.
Brown said she learned this week that her new refill of medicine was going to cost more than $150 and 鈥渁lmost passed out.鈥� She filled her car with only half the gas she needed, knowing she鈥檇 need money for the medications.
Anxieties about unexpected medical costs are acute, the poll shows. About three-quarters of people who had ACA insurance last year now say they are 鈥渧ery鈥� or 鈥渟omewhat鈥� worried about paying for emergency care or hospitalization, while about half said the same about routine medical visits or prescription drugs.
Some enrollees switch to lower-tier plans, while others drop coverage entirely
Most of last year’s enrollees, about 7 in 10, stayed on ACA health insurance 鈥� but that includes about 3 in 10 who changed plans within the marketplace. Meanwhile, about 2 in 10 became eligible for coverage through their employer, Medicare or Medicaid or purchased insurance outside of the ACA marketplace, which tends to be less comprehensive.
About 1 in 10 of last year鈥檚 enrollees said they altogether and are now uninsured, the poll shows.
Eric LeVasseur, a 63-year-old software developer in Seal Beach, California, was part of that group. He said when he saw his mid-tier, silver-level plan was going to nearly triple to $1,200 per month, 鈥渋t was not something my budget could absorb.鈥�
Many enrollees blame health insurance companies and politicians
About 7 in 10 returning ACA enrollees facing higher costs say they blame health insurance companies 鈥渁 lot,” while just over half put 鈥渁 lot鈥� of blame on Republican lawmakers, President Donald Trump and pharmaceutical companies. About one-third blamed Democrats in Congress or hospitals 鈥渁 lot,鈥� while about 1 in 10 placed this level of blame on doctors or employers.
Respondents who identified with a political party and saw costs rise overwhelmingly blamed the opposing party鈥檚 lawmakers 鈥渁 lot.”
James Mako, an engineer in Boca Raton, Florida, and a political independent, said he blames the Republican Party. His $500-per-month premiums were poised to double this year for his silver-level ACA health plan. So, he downgraded to a bronze-level plan with a higher deductible.
Mako said he鈥檚 not convinced by the ideas Republicans have floated to fix the problem, like funneling money into .
鈥淚 think they鈥檙e just sales gimmicks,鈥� he said. 鈥淭he subsidies should be back.鈥�
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The KFF poll was conducted Feb. 12-Mar. 2, 2026, among 1,117 U.S. adults who had Marketplace insurance in 2025, using a sample drawn from two probability-based panels. All of the respondents participated in the 2025 KFF Marketplace Survey and were recontacted for the new survey. The margin of sampling error for the full sample is plus or minus 3.8 percentage points.
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