By Anna Wilde Mathews
Nearly one in 10 people who had Affordable Care Act plans last year dropped health insurance altogether, after premium costs rose sharply because of the expiration of federal subsidies, according to a new survey.
Most of those who remained in ACA plans reported larger out-of-pocket healthcare expenses in the form of higher copays, coinsurance or deductibles, according to the survey from health-research nonprofit KFF. About one-sixth of those who still have ACA coverage, or 17%, weren't sure they would be able to afford their new premium payments for the entire year, indicating more people might drop insurance as the year goes on.
The survey is the broadest look yet at the fallout from the end of enhanced ACA subsidies, which lapsed at the start of this year, increasing premium bills for millions of enrollees. The higher healthcare costs have forced many ACA policyholders to make hard choices at a time when grocery and gas prices are also rising.
In February and early March, KFF polled 1,117 people who had ACA plans in 2025 and found that the most common reason people cited for dropping insurance was cost. Last year, more than 20 million people had ACA policies.
"Not only is there significant coverage loss, but there could be more to come," said Cynthia Cox, a senior vice president at KFF. She said the survey results were "about on target" compared to what had been expected.
Of those surveyed, 69% still have ACA policies this year. Beyond the 9% who said they are uninsured, 22% of respondents now have some other type of coverage, such as Medicare or employer-sponsored insurance.
Kelly Rose, 59 years old, who lives near Orlando, Fla., became uninsured this year because she couldn't pay the roughly $1,700 monthly bill to keep the ACA plan she had in 2025. "It's more than my mortgage," she said. The cost is a huge jump compared to 2025, when she got help from a subsidy, she said.
Though her job at a bank offers health insurance, she said she missed the enrollment window in the fall because she had planned to keep the ACA plan, not realizing how much it would cost.
Rose is now turning to a Canadian pharmacy to get her asthma medication, which costs $800 a month in the U.S.
Many of those who retained ACA plans are still in a 90-day grace period that allows them to keep their coverage even if they weren't making premium payments.
Among all survey respondents who still had ACA plans, 4% had yet to make a premium payment this year. More than half said they were cutting back spending on food, clothing or basic household items to afford healthcare.
The ACA changes, which were the subject of a political battle that led to the longest-ever government shutdown last year, are likely to become a flashpoint again in this fall's midterm elections. Democrats have blamed Republicans for failing to renew the expanded subsidies, and for growing healthcare costs. Republicans have argued the ACA is flawed and needs to be changed.
The KFF survey found that younger enrollees dropped out of ACA plans at a higher rate than older people. Typically, as health-insurance costs rise, healthier people are the most likely to forgo insurance, leaving a sicker, more costly pool of policyholders. The dynamic was one reason insurers sought big ACA rate increases for 2026. One major player, CVS Health's Aetna, pulled out of the ACA market completely.
During the ACA enrollment window, which lasted until mid-January in most states, 23 million people signed up for 2026 plans, according to the Centers for Medicare and Medicaid Services, down from 24.2 million a year earlier.
Write to Anna Wilde Mathews at Anna.Mathews@wsj.com
(END) Dow Jones Newswires
March 19, 2026 05:00 ET (09:00 GMT)
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