Marketplace Health Care Costs Rise for 51% of ACA Enrollees

Half of returning ACA Marketplace enrollees say their health care costs are "a lot higher" this year following expiration of enhanced premium tax credits in December 2025.

Objective Facts

Following the expiration of the enhanced premium tax credits in December 2025, half of those who have re-enrolled in ACA Marketplace coverage say their health care costs are "a lot higher" this year, after an open enrollment period that left many enrollees feeling "worried" and "angry." KFF researchers conducted a follow-up survey of 1,117 adults, more than 80% of those originally polled in late 2025, and found that 51% who returned to a marketplace plan in 2026 say their costs are "a lot higher," with most (80%) of those who reenrolled in an ACA plan saying their premiums, deductibles or coinsurance and copayments have increased this year. Close to three-quarters (73%) of those surveyed said they are either very or somewhat worried about their ability to afford emergency care or hospitalizations in their current plans. In terms of blame, 70% of those who reenrolled said health insurers share "a lot" of the blame, more than half (54%) cited Republicans in Congress, and 53% cited President Donald Trump.

Left-Leaning Perspective

Sen. Dick Durbin slammed the Trump Administration and congressional Republicans for failing to extend the enhanced premium tax credits that helped Americans afford their health care coverage on the Affordable Care Act marketplace, stating that congressional Republicans refused to extend them despite pressure from patients, physicians, and providers. Durbin noted that millions of people decided to drop their health insurance coverage during the 2026 open enrollment period, while others are being forced to make impossible choices between food, car payments, and housing costs, warning that if these problems are not solved immediately, millions of people will become uninsured. The Center on Budget and Policy Priorities documented that congressional Republicans failed to extend premium tax credit enhancements at the end of 2025, and enrollment has plummeted with many families making tough tradeoffs to afford health care alongside other basic needs. The organization reported that premiums people pay for marketplace coverage in 2026 more than doubled on average, and as a result, the number of people choosing a marketplace plan for 2026 fell for the first time since 2020 by 1.2 million people, a 5 percent decline. Casey Burgat, director of the legislative affairs program at The George Washington University's Graduate School of Political Management, argued that the GOP's political calculus appears to be that by making Obamacare work less efficiently, Americans will become frustrated with the law, with "most of it has to do with making things harder administratively." Progressive analysis emphasizes that the cost increases and enrollment drops are direct consequences of Republican policy choices rather than program failures inherent to the ACA itself.

Right-Leaning Perspective

Republicans said policy changes in the "big beautiful bill" are due to concerns about waste, fraud and abuse, with the Paragon Health Institute calling them "commonsense program integrity provisions" to reduce fraud and spending and to cut back on the "Biden administration's approach of maximizing enrollment at any cost." Republican lawmakers cited fraud as a key reason not to extend the subsidies, pointing to a Government Accountability Office report, with Senate Majority Leader John Thune, R-S.D., stating that the Democrats' proposal to extend ACA enhanced credits "is rampant — and I say rampant — with fraud and abuse." Vice President JD Vance argued that "the tax credits actually go to a lot of waste and fraud within the insurance industry" and "we want to make sure that the tax credits go to the people who need them." Brian Blase of the Paragon Health Institute used pre-COVID enrollment data showing payment failure rates from 2014-2019, projecting that about 19 million people would be enrolled by year's end in 2026, and claimed the "market would be 90% higher than the pre-COVID average." However, some Republicans appear to view the policy as strategically beneficial, with the calculation that by making Obamacare work less efficiently, Americans will become frustrated with the law, giving lawmakers political cover to eventually replace it. Conservative framing emphasizes policy integrity concerns over affordability impacts.

Deep Dive

The expiration of enhanced premium tax credits at the end of 2025 is the proximate cause of the cost increases facing the 51% of returning enrollees reporting significantly higher premiums. Congress passed the American Rescue Plan Act in 2021 during the COVID-19 pandemic to temporarily increase tax credits available for ACA Marketplace purchases, extended those credits through 2025 via the Inflation Reduction Act, but allowed them to expire at the end of 2025. The majority of insurers also took into account the potential expiration of enhanced premium tax credits in their premium rate increases, with the expiration leading to out-of-pocket premiums increasing by an average of more than 75%, as insurers expected healthier enrollees to drop coverage. On the left, the emphasis is that the 51% increase in costs reflects two distinct failures: Congressional Republicans' refusal to extend subsidies, and the Trump administration's additional regulatory changes that further tighten eligibility and increase administrative burden. The Trump Administration finalized a rule for ACA marketplaces that changes the calculation of premium tax credits and lets insurers raise out-of-pocket charges, raising the annual cost of health coverage by hundreds of dollars for most of the 23 million people in the ACA marketplace. On the right, the framing is that high costs reflect either the underlying problem of subsidies inflating the market, or the necessary response to fraud that Democrats want to ignore. Both sides cite the KFF data showing rising costs, but interpret causation differently—one pointing to policy decisions to end subsidies, the other to market fundamentals and fraud concerns. What remains to be seen is how the enrollment losses and household financial stress will play out politically. Nearly half of registered marketplace voters (48-49%) say health care costs will have a major impact on their 2026 midterm voting, with Democrats more than twice as likely as Republicans to say costs will have major impact (67% vs. 27%). This suggests health care affordability may become a significant 2026 campaign issue, particularly in states with the steepest enrollment declines.

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Marketplace Health Care Costs Rise for 51% of ACA Enrollees

Half of returning ACA Marketplace enrollees say their health care costs are "a lot higher" this year following expiration of enhanced premium tax credits in December 2025.

Jun 3, 2026
Marketplace Health Care Costs Rise for 51% of ACA EnrolleesVia Wikimedia (contextual reference image) · Subscribe to support objective journalism and fund real-time news imagery
What's Going On

Following the expiration of the enhanced premium tax credits in December 2025, half of those who have re-enrolled in ACA Marketplace coverage say their health care costs are "a lot higher" this year, after an open enrollment period that left many enrollees feeling "worried" and "angry." KFF researchers conducted a follow-up survey of 1,117 adults, more than 80% of those originally polled in late 2025, and found that 51% who returned to a marketplace plan in 2026 say their costs are "a lot higher," with most (80%) of those who reenrolled in an ACA plan saying their premiums, deductibles or coinsurance and copayments have increased this year. Close to three-quarters (73%) of those surveyed said they are either very or somewhat worried about their ability to afford emergency care or hospitalizations in their current plans. In terms of blame, 70% of those who reenrolled said health insurers share "a lot" of the blame, more than half (54%) cited Republicans in Congress, and 53% cited President Donald Trump.

Left says: Progressive voices argue that congressional Republicans refused to extend the enhanced tax credits despite pressure, forcing millions to drop coverage and others to make impossible choices between food, car payments, and housing costs.
Right says: Republican lawmakers cited fraud as a key reason not to extend the subsidies, pointing to a Government Accountability Office report on fraud tied to ACA subsidies.
✓ Common Ground
Both the Trump administration and health policy analysts across the spectrum acknowledge that some level of fraud and inappropriate enrollment exists in the ACA marketplace that warrants attention.
Several commentators across the political spectrum agree that the primary driver of enrollment loss is cost, with Georgetown University's Sabrina Corlette stating "in economic theory, no matter whether one is left, right, or center, it's a simple fact that when you raise prices of something, fewer people will buy it."
There appears to be agreement that the current drop-off rate in enrollment aligns with what policy experts predicted, partly because Congress did not extend the generous benefits that expired at the end of 2025.
Objective Deep Dive

The expiration of enhanced premium tax credits at the end of 2025 is the proximate cause of the cost increases facing the 51% of returning enrollees reporting significantly higher premiums. Congress passed the American Rescue Plan Act in 2021 during the COVID-19 pandemic to temporarily increase tax credits available for ACA Marketplace purchases, extended those credits through 2025 via the Inflation Reduction Act, but allowed them to expire at the end of 2025. The majority of insurers also took into account the potential expiration of enhanced premium tax credits in their premium rate increases, with the expiration leading to out-of-pocket premiums increasing by an average of more than 75%, as insurers expected healthier enrollees to drop coverage.

On the left, the emphasis is that the 51% increase in costs reflects two distinct failures: Congressional Republicans' refusal to extend subsidies, and the Trump administration's additional regulatory changes that further tighten eligibility and increase administrative burden. The Trump Administration finalized a rule for ACA marketplaces that changes the calculation of premium tax credits and lets insurers raise out-of-pocket charges, raising the annual cost of health coverage by hundreds of dollars for most of the 23 million people in the ACA marketplace. On the right, the framing is that high costs reflect either the underlying problem of subsidies inflating the market, or the necessary response to fraud that Democrats want to ignore. Both sides cite the KFF data showing rising costs, but interpret causation differently—one pointing to policy decisions to end subsidies, the other to market fundamentals and fraud concerns.

What remains to be seen is how the enrollment losses and household financial stress will play out politically. Nearly half of registered marketplace voters (48-49%) say health care costs will have a major impact on their 2026 midterm voting, with Democrats more than twice as likely as Republicans to say costs will have major impact (67% vs. 27%). This suggests health care affordability may become a significant 2026 campaign issue, particularly in states with the steepest enrollment declines.

◈ Tone Comparison

Progressive outlets and officials use language like "manufactured a health care crisis" to describe Republican actions. Republicans employ phrases like "rampant with fraud and abuse" while discussing "waste and fraud within the insurance industry." Left-leaning analysis emphasizes human suffering and policy choices, while right-leaning analysis emphasizes program integrity concerns and market efficiency arguments.