About 8 in 10 Americans who re-enrolled in Affordable Care Act marketplace coverage report higher health care costs this year, with roughly half saying their costs are "a lot" higher, according to a new survey from the health care research nonprofit KFF.

The primary driver of increased costs was the December 31 expiration of enhanced tax credits that had offset premiums for most enrollees during the COVID-19 pandemic. The subsidies, which Democrats in Congress fought to extend, faced opposition from Republican leadership, and efforts toward a bipartisan compromise collapsed in January.

The cost increases are forcing difficult choices for many of the 23 million ACA enrollees. About 55% of the 1,117 Americans surveyed said they plan to cut spending on food and other basic household needs to manage health care costs. Some patients are rationing medications, including insulin for diabetes management, to make prescriptions last longer.

About 10% of last year's ACA enrollees dropped coverage entirely and are now uninsured, the poll found. Another 30% changed plans within the marketplace, often switching to lower-tier options with higher deductibles. Additionally, about 20% became eligible for coverage through employers, Medicare, Medicaid, or purchased insurance outside the ACA marketplace.

The survey shows widespread anxiety about medical expenses, with about three-quarters of respondents expressing worry about paying for emergency care or hospitalization. About half expressed similar concerns about routine medical visits or prescription drugs.

Regarding blame for the increased costs, about 70% of returning ACA enrollees facing higher costs placed significant blame on health insurance companies, while just over half blamed Republican lawmakers, President Donald Trump, and pharmaceutical companies. About one-third blamed Democrats in Congress or hospitals, while roughly 10% blamed doctors or employers. The KFF poll was conducted February 12 through March 2 among adults who had marketplace insurance in 2025, with a margin of error of plus or minus 3.8 percentage points.