Millions of ACA Healthcare Plan Enrollees Uninsured After Enhanced Subsidies End

Around 22 million Americans received enhanced federal subsidies for Affordable Care Act (ACA) marketplace health insurance in 2025. However, the expiry of these subsidies, which were designed to reduce monthly premiums, left every 1 in 10 people enrolled in an ACA marketplace health plan last year uninsured.

The health policy research group KFF found in its latest survey of 1,000 US adults enrolled in an ACA marketplace health plan in 2025 that the expiry of subsidies also compelled millions of people to downgrade their health insurance amid higher premiums and rising unemployment.

The recent survey found that the lapse of subsidies drove health premiums for the average ACA enrollee to more than double in 2026. 'Returning enrollees are really struggling with costs,' said KFF survey manager Lunna Lopes.

Major concerns about healthcare costs arise as Americans struggle with affordability, especially amid surging gas prices driven by the Middle East crisis, which threatens higher inflation and grocery prices. According to Lopes, US households that dropped their health insurance coverage due to rising costs face 'a lot of concerns and worries about what to do if they get sick.'

More People to Drop Their ACA Coverage

Those who kept their ACA health coverage are also straining their household budgets to stay insured. The survey showed that 17% of returning enrollees aren't confident they can afford the higher premiums and could drop their insurance coverage in 2026.

The Congressional Budget Office forecast last month that total enrollment in ACA marketplace health plans is expected to decline to 12.5 million by 2028, about 50% of last year's enrollment and erasing all gains in marketplace signups since 2021, when the subsidies were implemented.

That enrollment reduction is also due to other changes, like administrative revisions in the US President Donald Trump's 'big, beautiful bill' that make it more challenging for people to sign up for and keep their insurance coverage.

As many as 28% of survey respondents plan to keep ACA marketplace coverage but chose a different health plan. There are four tiers: platinum, gold, silver, and bronze, and many people downgraded to bronze plans for lower upfront premiums, but they generally lead to higher out-of-pocket expenses during claims.

A total of 55% who enrolled again in an ACA marketplace plan this year have trimmed or plan to reduce their household expenses on food and clothing to afford healthcare costs. At the same time, 43% of the survey respondents are also looking for an extra job or work hours, 23% are delaying bill payments, and 21% are taking out a loan due to the higher premiums.

The expiration of enhanced ACA subsidies took centre stage in the record-long government shutdown last year. While democrats fought hard to extend them, a majority of Republicans voted against doing so.

'We know how close some of these elections could be,' Lopes said, adding, 'Changes in health-care coverage and health-care costs do seem like something that will impact how they approach the election and whether they decide to turn out and vote and who they may choose to vote for.'

KFF pollsters, in February and early March, surveyed 1,117 U.S. adults, more than 80% of the ACA enrollees originally polled in November, online and by telephone. The margin of error is plus or minus 4 percentage points for the full sample, according to a KFF statement.