KFF Survey: Rising Cost of ACA Coverage Poses Serious Concern

December 04, 2025

Americans shopping for plans on Affordable Care Act marketplaces are bracing for significant increases—and some may opt out of coverage if costs double, according to a new survey.

The report, released today from the Kaiser Family Foundation (KFF), found that 1 in 3 enrollees would “very likely” shop for lower cost plans if their premiums doubled, and 1 in 4 would “very likely” go without insurance.

“The poll shows the range of problems Marketplace enrollees will face if the enhanced tax credits are not extended in some form, and those problems will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences,” KFF President and CEO Drew Altman said in a statement.

Here are five things to know:

• The stakes:  Without an extension, average premium payments would increase 114 percent on average.
  • In Pennsylvania, enrollees will pay 82 percent or more for coverage without subsidies, per state officials.
• Popular support:  The overwhelming majority (84%) of ACA enrollees (including 95% of Democrats and 72%t of Republicans) support an extension of the tax credits.
  • Eighty-nine percent expect to make a decision by the end of this year
• Statewide impact:  Leaders from Pennsylvania’s health insurance marketplace, Pennie, have estimated 150,000 Pennsylvanians could drop health insurance if enhanced premium tax credits are not extended.
• Key issue:  The cost of coverage and premium support will be an issue to watch next year. About half of enrollees said it would have a “major impact” on their 2026 midterm votes if expenses increase by $1,000.
• Legislative activity:  As part of the deal to end the government shutdown last month, the U.S. Senate is expected to vote on proposals that would address the expiring premium assistance. Both parties are expected to release details of their plans shortly.

HAP continues to call on Congress to extend vital premium assistance that protects access to care for thousands of Pennsylvanians. For questions, contact John Myers, vice president, federal advocacy.

The latest KFF marketplace survey is available online.