As the latest KFF Health Tracking Poll shows, affordability is the public’s biggest concern, with the cost of health care ranking as their top economic worry. However, KFF polls have demonstrated that beyond costs, insured people report a whole host of issues navigating the health care system. This report looks at which aspects of accessing care and health insurance are the biggest problem for insured adults and finds that prior authorizations – or the process of having to get insurance approval before accessing certain tests, treatments, or medications – are having an outsized impact on insured adults.

One in three insured adults in the U.S. say they find prior authorizations a “major burden” to getting health care. An additional four in ten (37%) say the process is a “minor burden,” bringing the total share of insured adults who find the process burdensome to about seven in ten (69%). This is larger than the share who say other aspects are burdensome such as understanding bills or what is owed (60%), getting needed appointments (60%), or finding providers who accept their insurance (53%).

When asked to choose which aspect of getting health care, beyond costs, is the single biggest burden, one in three insured adults (34%) choose prior authorizations, followed by getting needed appointments (19%), understanding their bill (17%), or finding providers who accept their insurance (15%). The choice of prior authorizations as the single biggest burden is even more stark among adults with a chronic condition that requires ongoing medical treatment (about half of all adults). These individuals often require more treatments and medications, resulting in more interactions with health insurance companies and health care providers. Four in ten (39%) insured adults with a chronic condition say prior authorizations are the single biggest burden when it comes to getting health care, at least twice the share who say the same about the other aspects of health care asked about.

Prior authorizations are also identified as the single biggest burden for insured adults across partisans, as well as among individuals across insurance types that typically require prior authorizations such as individuals with Medicaid, people who buy their own health insurance, and people who get health insurance through an employer. Notably, about three in ten (28%) Medicaid enrollees identify finding providers who accept their insurance as the biggest burden, but small shares identify other issues as their biggest burden.¹

During the prior authorization process, some treatments or medications recommended by a provider may be delayed and, in some instances, an insurance company may end up denying medication or treatment. Overall, about two-thirds of adults say delays and denials of health care services by health insurance companies are a “major problem” with an additional one in four (24%) who say they are a “minor problem.” Just one in ten adults say delays and denials of services by insurance companies are not a problem in our current health care system.  More than six in ten across Medicaid enrollees, self-purchasers, and those with employer coverage say the delays and denials of care by insurance companies are a “major problem.”

About one in three insured adults (33%) say they have had a health insurance company deny coverage for a certain health care service treatment, or medication prescribed by their doctor in the past two years. Three in ten insured adults say that a health insurance company has delayed their ability to get such services, treatments, or medications (29%) or required them to try a lower-cost drug or treatment before covering the one that was originally recommended by their provider (29%). These issues are even more common among insured adults with a chronic condition with about four in ten reporting that an insurance company has required them to try a lower-cost drug or treatment (38%), deny coverage for a certain service or medication (42%), or delayed their ability to get prescribed care (37%). Overall, nearly half (47%) of insured adults say they have had a certain service, treatment, or medication either denied or delayed in the past two years, rising to nearly six in ten (57%) among those with a chronic condition.

Denial and delays by health insurance companies can lead to negative consequences for people’s physical, mental, and financial health. One in three of those who experienced a denial or delay say the actions required by their health insurance company had a “major negative impact” on their mental health and emotional well-being as well as on their finances (about one in six of all insured adults).  One in four (one in eight of all insured adults) say the delays or denials has a “major negative impact” on their physical health.

 

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1. Prior authorization is more common in Medicare Advantage than Traditional Medicare. Because this analysis is unable to break out individuals with traditional Medicare versus Medicare Advantage, we do not include Medicare as a subgroup in our analysis. These individuals are included in both the total group and the group with chronic conditions.  To learn more about prior authorizations for Medicare, more available at https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/. ↩︎

This KFF Health Tracking Poll/KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English (n=1,355) and in Spanish (n=71). The sample includes 1,028 adults (n=60 in Spanish) reached through the SSRS Opinion Panel either online (n= 1,003) or over the phone (n=25). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails. 

Another 398 (n=11 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 149 were interviewed by phone and 249 were invited to the web survey via short message service (SMS). 

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail or an electronic gift card incentive. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, 2 cases was removed. 

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2025 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure. 

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research. 

Note: The data presented below are updated monthly as new Medicaid/CHIP enrollment data become available.

The Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project as well as archived data on renewal outcomes reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data were pulled from state websites, where available, and from CMS.

Medicaid/CHIP Enrollment Trends

Medicaid/CHIP enrollment trends generally use February 2020 as the baseline month because it was the month prior to the start of the COVID-19 pandemic and implementation of the continuous enrollment provision. During continuous enrollment, which was in place during the three years of the pandemic, states paused Medicaid disenrollments. As a result, when the continuous enrollment provision ended in March 2023, national Medicaid/CHIP enrollment had increased to a record high of 94 million enrollees. Beginning April 1, 2023, states could resume disenrolling people after conducting renewals to verify eligibility for the program, though some states delayed the start of their unwinding periods until May, June, or July 2023. Most states took 12 months to complete unwinding renewals and nearly all states completed renewals by August 2024.

The figures below show Medicaid and CHIP enrollment from February 2020 through the most current month of available data. Some figures also include enrollment for adults and children in Medicaid/CHIP. Key enrollment trends as of October 2025 include:

• There are 76.8 million people enrolled in Medicaid/CHIP nationally (Figure 1). This represents an 19% decline from total Medicaid/CHIP enrollment in March 2023, but is still 7% higher than Medicaid/CHIP enrollment in February 2020, prior to the pandemic (Figure 2 and Table 1).
• Several factors likely explain why national Medicaid/CHIP enrollment is higher than pre-pandemic enrollment. The pandemic may have encouraged some people who were previously eligible for Medicaid but not enrolled to newly enroll in the program. During the unwinding, many states took steps to improve their renewal processes, which reduced the number of people who were disenrolled despite remaining eligible. In addition, some states expanded eligibility for certain groups since the start of the pandemic, such as the Affordable Care Act’s (ACA) Medicaid expansion.
• Medicaid/CHIP enrollment is higher than pre-pandemic levels in all but fourteen states (AK, AR, CO, ID, IA, LA, MI, MT, NH, NM, SC, TN, TX, and WV). Enrollment changes from pre-pandemic baseline vary from a 17% decrease in Montana to a 54% increase in North Carolina (Figure 2). Many of the states with the largest increases in enrollment expanded eligibility since the start of the pandemic. For example, five states (NE, OK, MO, SD, and NC) implemented the Medicaid expansion between October 2020 and December 2023 and Maine increased the income limit for children to qualify for Medicaid.
• In the 49 states and DC with complete enrollment data by age, there are 35.9 million children (48%) and 39.2 million adults (52%) enrolled, a change from pre-pandemic (February 2020) enrollment patterns when children made up a slight majority (51%) of Medicaid/CHIP enrollees (Figure 1).
• Child enrollment in Medicaid/CHIP is below pre-pandemic enrollment in 20 states, while adult enrollment is below pre-pandemic levels in 12 states (Figure 2).
• There are 69.5 million people enrolled in Medicaid and 7.2 million people enrolled in CHIP (Figure 1). More states report Medicaid enrollment above their pre-pandemic baselines compared to the number reporting CHIP enrollment above the baseline (Figure 2).

Note: The data on unwinding renewal outcomes presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again.

As of September 12, 2024 and with nearly complete unwinding data for most states: 

• Over 25 million people were disenrolled (31% of completed renewals) and over 56 million people had their coverage renewed (69% of completed renewals).  
• Disenrollment rates varied across states from 57% in Montana to 12% in North Carolina, driven by a variety of factors including differences in renewal policies and procedures as well as eligibility expansions in some states.  
• Among those who were disenrolled, nearly seven in ten (69%) were disenrolled for paperwork or procedural reasons while three in ten (31%) were determined ineligible.  
• Among those whose coverage was renewed during the unwinding, 61% were renewed on an ex parte, or automated, basis, meaning the individual did not have to take any action to maintain coverage. 

State Data on Renewal Outcomes

The data on unwinding-related renewal outcomes presented in this section rely primarily on monthly reports that states were required to submit to the Centers for Medicare & Medicaid Services (CMS) during the unwinding period. The data also reflect updates to the monthly reports that states submit three months after the original report submission to account for the resolution of pending cases and any other changes in renewal metrics. For 13 states, data were pulled from dashboards or reports published on state websites that provide more complete information, and for a few additional states, updated monthly reports were pulled from state websites because they were more timely than what is reported on the CMS website. 

To view archived data for specific states, click on the State Data – Archived tab.

 

  

Medicaid Disenrollments

• As of September 12, 2024, at least 25,198,000 Medicaid enrollees had been disenrolled during the unwinding of the continuous enrollment provision. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 56.4 million enrollees, had their coverage renewed.
• There is wide variation in disenrollment rates across reporting states, ranging from 57% in Montana to 12% in North Carolina. A variety of factors contribute to these differences, including differences in renewal policies and system capacity. Some states adopted policies that promote continued coverage among those who remain eligible and/or have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems. In addition, North Carolina and South Dakota adopted Medicaid expansion and other states increased eligibility levels for certain populations (e.g., children, parents, etc.) during the unwinding, which may have lowered disenrollment rates in these states.

 

• Across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. However, these rates vary based on how they are calculated (see note below). Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage. 

(Note: The first tab in the figure below calculates procedural disenrollment rates using total disenrollments as the denominator. The second tab shows these rates using total completed renewals, which include people whose coverage was terminated as well as those whose coverage was renewed, as the denominator. And finally, the third tab calculates the rates as a share of all renewals due, which include completed renewals and pending cases.)

Medicaid Renewals

• Of the people whose coverage has been renewed as of September 12, 2024, 61% were renewed on an ex parte basis while 39% were renewed through a renewal form, though rates vary across states. Under federal rules, states are required to first try to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. Ex parte renewal rates varied across states from 90% or more in Arizona, North Carolina, and Rhode Island to less than 20% in Pennsylvania and Texas. 

Federal Data on Renewal Outcomes

The data presented here are cumulative unwinding metrics published by CMS. These counts and percentages may differ from the above data, which present renewal metrics reported on state websites when state-reported data are more complete.  

Figure 1 below shows cumulative renewal data reported by CMS during states’ unwinding periods. Renewal data for the months after the end of states’ unwinding period are excluded. The data reflect updated unwinding data reported by states three months after the original monthly reports as they become available.   

For questions about this tracker, please contact KFFTracker@kff.org

Note: The state data presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again. 

The data presented here provide state-level data on enrollment trends and renewal outcomes during the unwinding period. Figure 1 shows total Medicaid enrollment by month starting in January 2023 and, once disenrollments resumed in a state, the cumulative percent change in Medicaid enrollment relative to the month before Medicaid disenrollments started (this baseline month will differ across states). Figure 2 shows renewal metrics for each month of a state’s unwinding period (or cumulative data for the unwinding period for some states). 

For total national Medicaid enrollment, click on the Enrollment Data tab.

Resources on unwinding data

• An Examination of Medicaid Renewal Outcomes and Enrollment Changes at the End of the Unwinding
• How Did Medicaid Renewal Outcomes Change During the Unwinding?
• KFF Survey of Medicaid Unwinding
• Three Questions About Medicaid Unwinding: What We Know and What to Expect
• Halfway Through the Medicaid Unwinding: What Do the Data Show?
• Unwinding of Medicaid Continuous Enrollment: Key Themes from the Field
• Navigating the Unwinding of Medicaid Continuous Enrollment: A Look at Enrollees Experiences
• Six Months into the Medicaid Unwinding: What Do the Data Show and What Questions Remain?
• What Do Medicaid Unwinding Data by Race and Ethnicity Show?
• Understanding Medicaid Ex Parte Renewals During the Unwinding
• States Obtain Special Waivers to Help Unwinding Efforts
• Understanding Medicaid Procedural Disenrollment Rates
• Do State Decisions to Prioritize Renewals for Medicaid Enrollees Who are Likely Ineligible Affect Early Disenrollment Rates?
• What Do the Early Medicaid Unwinding Data Tell Us?
• How Many People Might Lose Medicaid When States Unwind Continuous Enrollment?

Resources on state policies and preparations for the unwinding

• A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond
• State Policy Choices Are Likely to Affect the Extent of Medicaid Enrollment Declines During the Unwinding Period
• Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for the Unwinding of the Pandemic-Era Continuous Enrollment Provision
• The Unwinding of Medicaid Continuous Enrollment: Knowledge and Experiences of Enrollees
• Unwinding the Continuous Enrollment Provision: Perspectives from Current Medicaid Enrollees

Resources on pre-pandemic enrollment patterns and coverage transitions

• What Happens After People Lose Medicaid Coverage?
• Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends
• Unwinding the PHE: What We Can Learn From Pre-Pandemic Enrollment Patterns
• Medicaid Enrollment Churn and Implications for Continuous Coverage Policies
• Implications of Continuous Eligibility Policies for Children’s Medicaid Enrollment Churn
• Medicaid Enrollment Patterns During the Postpartum Year

KFF’s unwinding explainer

• 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

Key Takeaways

• The cost of health care, including paying for health insurance and out-of-pocket expenses, tops the list of the public’s economic anxieties, rising well above other necessities. Two-thirds of the public (66%) say they worry about being able to afford health care for them and their family, ranking higher than utilities, food and groceries, housing, and gas. In addition, most adults (55%) say their health care costs have gone up in the past year, including at least one in five who say they have increased at a faster rate than food or utilities. A majority (56%) of the public say they expect health care costs for them and their families to become even less affordable in the coming year.
• With health care costs topping the list of economic worries across partisans and key groups, voters expect the issue to play a major role in their decisions to turnout in November’s midterm elections as well as which candidates they support. Majorities across partisans say health care costs will impact their vote in November, but the issue is resonating more with Democratic voters and independent voters. More than three-quarters of Democratic voters and independent voters say health care costs will impact both their decision to vote and which party’s candidate they will vote for in the election, compared to about half of Republican voters. In fact, two-thirds of Democratic voters and more than four in ten independent voters say health care costs will have a “major impact” on their 2026 voting decisions.
• The Democratic Party has the advantage when it comes to which party voters trust to handle most health care issues, including health care costs, on which the Democrats have a 13-point advantage over Republicans. The one exception is prescription drug prices, an issue President Trump has focused on in his second term, and on which similar shares of voters say they trust the Democratic Party (35%) and the Republican Party (30%). Among independent voters, the Democratic Party has an edge over the Republican Party on health care issues, but many independent voters also say they don’t trust either party.
• The public’s anxiety around health care costs comes at a time when the Senate and President Trump seem unlikely to revive the ACA enhanced premium tax credits, which expired on January 1^st. Most (67%) of the public say Congress did the “wrong thing” by not extending the credits, including large majorities of Democrats (89%) and independents (72%). But majorities of Republicans (63%) including MAGA supporters (64%) say Congress did the “right thing” by not extending the ACA enhanced premium tax credits. While overall popularity of the ACA and the Marketplaces is still high, given the recent debate around the ACA enhanced tax credit debates, favorability has declined among Republicans.

Health Care Costs Top Public’s Concerns During Moment of Economic Anxiety

One year into the second term of President Trump and less than ten months before the 2026 midterm elections, the public remains concerned about the top issue of the 2025 election – the economy. Eight in ten (82%) adults say their cost of living has increased in the past year, including half who say it has increased “a lot.” Very few say their cost of living has “decreased” either “a little” (4%) or “a lot” (1%) while about one in ten say their living expenses have remained stable over the past year. Many adults, regardless of partisanship, say their cost of living has increased “a lot” in the past year, including a majority of (56%) Democrats, about half (53%) independents, and four in ten (41%) Republicans. About four in ten (38%) supporters of the Make America Great Again Movement (MAGA) also say their cost of living has increased “a lot” in the past year.

Concerns about household spending coincide with a majority (71%) of the public saying President Trump is not focusing enough on domestic affairs, such as addressing the cost of living in the U.S. The share of the public who say President Trump is not paying enough attention to domestic concerns rises to about nine in ten (89%) Democrats and three-quarters of (76%) independents. On the other hand, a majority of the public (55%) also say the Trump administration is focusing “too much” on foreign affairs, such as actions in Venezuela, Ukraine, and Gaza. Republicans and MAGA supporters are more positive about President Trump’s priorities, with many saying he is spending the “right amount” on both domestic affairs (53% and 60%), and foreign affairs (66% and 76%).

The latest KFF Health Tracking Poll finds health care costs top the list of what the public worries about being able to afford for themselves and their family. Two-thirds (66%) of the public say they worry about paying for health care, including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs, ranking higher as a financial worry than other household expenses like utilities, food, and rent or mortgage – all three items on which a majority of Americans are still worried about being able to afford.  About a third of adults (32%) say they are “very worried” about affording health care expenses, while about a quarter of adults say the same about being able to afford food and groceries (24%), their rent or mortgage (23%), or utilities (22%). About a fifth of adults say they are “very worried” about affording gas and transportation costs (17%). This comes as recent reports show that health care costs are on the rise for most Americans and the Affordable Care Act (ACA) enhanced tax credits, which benefitted most people who purchased insurance through the marketplace, have expired.

Notably, health care costs are the biggest worry compared to other household expenses for all adults, regardless of partisanship. About one third of Democrats (36%) and Independents (34%) say they are “very” worried about affording health care, as are about one in four (24%) Republicans. This includes one in four MAGA Republicans (23%) and non-MAGA Republicans (24%).

One reason why health care expenses may be topping the list of household worries is that most adults say their health care costs have increased in the past year, including a substantial share who say these costs have increased at a faster rate than other household expenses.

Overall, more than half (55%) of adults say their health care costs have increased in the past year. This includes about two-thirds of people with employer-based health insurance (64%) and those who purchase their own coverage (66%), as well as about half (53%) of Medicare enrollees 65 and older. Perceptions about the increase of health care costs persist across partisanship, with about half or more across partisans saying their health care costs have increased in the past year, including 58% of Democrats, 56% of independents, and 51% of Republicans, including 47% of MAGA Republicans.

Notably, about one in five of all adults say their health care costs have increased at a faster rate than other necessities like utilities (23%) and food and groceries (21%). This includes similar shares among partisans and MAGA supporters, as well as at least one in four with employer-sponsored insurance and about a third who purchase their own insurance. Smaller shares of adults who receive health insurance through Medicaid and Medicare say their health care costs have increased at a faster rate than utilities and food and groceries, suggesting those with government coverage are more insulated from the rising cost of health care.

Looking ahead to the next year, a majority (56%) of adults expect their family’s health care costs to become less affordable, while about a third (35%) expect them to stay about the same, and one in ten (9%) expect them to be more affordable. Most Democrats (62%) and independents (58%) expect health care costs to become less affordable, while Republicans, including those who identify as MAGA Republicans are split, with similar shares saying they expect them to become less affordable or expect them to say about the same. Majorities across insurance types expect their health care costs to become less affordable. This includes two-thirds of those who self-purchase (64%) or have employer-sponsored insurance (60%) and majorities of those who are uninsured (57%) or who have coverage through Medicaid (55%).

Democrats Have an Advantage on Health Care Issues, But No Party Has an Advantage on the Cost of Living 

With health care costs on the rise and a significant source of worry for many, a majority of voters, regardless of partisanship, say the issue will play a role in their voting decisions. The cost of health care is a particularly strong motivator for Democratic voters, of whom more than eight in ten say it will impact their decision to vote and who they will vote for, including two-thirds who say it will have a “major impact.” The cost of health care is a similarly large motivator for independents, of whom about eight in ten say it will impact their vote, including more than four in ten who say it will have a “major impact.” While Democratic and independent voters are more likely to say health care costs are a strong motivator compared to Republican voters, substantial shares of Republican voters say it will impact their decisions in November as well. Six in ten (60%) Republican voters say it will impact their decision to vote and 56% say it will impact which party’s candidate they will vote for. This includes about a fifth of Republican voters who say the cost of health care will have a “major impact.” This suggests that rising health care costs resonate with voters across the board and will be a key voting issue to watch for in this November’s elections.

Less than ten months before the 2026 midterm elections, the Democratic Party has a strong edge over the Republican Party when it comes to health care issues, including on the cost of health care. Democrats have a double-digit advantage over the Republicans when it comes to who voters trust on determining the future of Medicaid (43% vs. 25%), addressing the future of the ACA (42% vs. 26%), determining the future of Medicare (40% vs. 26%), and addressing the cost of health care (40% vs. 27%). Voters are more divided on which party they trust to address the cost of prescription drugs, an issue that President Trump has focused on during his second term. Notably, on every health care issue asked about, at least a quarter of voters say they trust neither party to do a better job.

Unsurprisingly, on each health care issue polled, Democratic voters are more likely to say they trust the Democratic Party and Republican voters are more likely to say they trust the Republican Party. Among independent voters, the Democratic Party has a clear advantage over the Republican Party on each of the health care issues; however, sizeable shares of independent voters (between about one-third and four in ten) say they trust “neither” party. When it comes to addressing the cost of prescription drugs, a larger share of independent voters say they trust “neither party” than say they trust either the Democrats or the Republicans.

While the Democrats have an advantage among voters overall on health care issues, voter confidence is low when it comes to both political parties and President Trump to address the cost of living. Most voters say they have “not too much” confidence or “none” in the Republicans in Congress (64%), the Democrats in Congress (63%), and President Trump (61%), to address the cost of living for people like them. Small and similar shares of voters overall say they have “a lot” or “some” confidence in President Trump (38%), Democrats in Congress (37%), or Republicans in Congress (36%) to address the cost of living.

Amid the ACA Tax Credits Debate, Favorability of the ACA and ACA Marketplace Remains High, but Has Declined Among Republicans  

While a majority of the public continues to express a favorable view of the ACA, Republicans’ views have soured recently in the wake of the debate over extending the enhanced tax credits and Republican lawmakers’ persistent attacks on the 2010 health care law. Overall favorability of the ACA has dropped in the most recent poll, with 58% now saying they have a favorable view of the law and 41% saying they have an unfavorable view (down from 64% favorable, 35% unfavorable in September 2025). The overall decline in favorability of the ACA is driven by Republicans, of whom one in five (22%) now say they have a “very” or “somewhat” favorable view, compared to one-third (36%) who said the same in September. Views of the ACA remain positive and stable among Democrats (91%) and independents (62%), as well as among individuals who buy their own health coverage (64%).

Favorable views of the ACA marketplaces where people and small businesses owners can shop for health insurance have also declined from 70% in September 2025 to 62% in the latest KFF Health Tracking Poll. Similarly to views of the ACA overall, this shift is driven by Republicans (41% now vs. 59% in September 2025 who said they view the marketplace favorably). Views of the ACA marketplaces are stable and favorable among Democrats (81%), independents (64%), and among those who self-purchase their insurance (64%).

Most Say Congress Did the “Wrong Thing” Not Extending the ACA Tax Credits

The public is largely critical of Congress not extending the ACA enhanced tax credits for people who buy their own health coverage. Two-thirds of the public say Congress did the “wrong thing” by not extending the ACA enhanced tax credits, compared to one-third who say Congress did the “right thing.” Majorities of Democrats (89%), independents (72%), non-MAGA Republicans (54%), and those who purchase their insurance themselves (67%) say Congress did the “wrong thing” by not extending the tax credits. While most (63%) Republicans say Congress did the “right thing” by not extending the tax credits, a sizeable share, about four in ten (37%), say Congress did the “wrong thing.” This marks a shift in views from when debates over to extend the tax credits or not were still ongoing in November, when half of Republicans said Congress should extend the tax credits, suggesting the debates have shifted opinion among the Republican base.

Among those who think the enhanced tax credits should have been extended, a group that leans more Democratic, many say most of the blame either falls on President Trump (42%, 28% of total adults) or Republicans in Congress (38%, or 26% of total adults). About one in five (19%, or 13% of total adults) say Democrats in Congress deserve the most blame. Among the four in ten Republicans who say Congress did the “wrong thing” not extending the tax credits, two-thirds (64%) blame Democrats in Congress for their expiration, rising to seven in ten (72%) MAGA-supporters.

There are some indications that the expiration of the enhanced tax credits will play a role in how voters make decisions in the coming November election. Among those who self-purchase their insurance, two-thirds say it will impact their decision to vote (66%) and which party’s candidate they will vote for (67%) in the upcoming election. And although the expiring enhanced premium tax credits directly affect only those who purchase their own coverage on the ACA marketplaces, among voters overall, six in ten (62%) say their expiration will have an impact on their decision to vote, including 30% who say it will have a “major impact” and 31% who say it will have a “minor impact.” An additional four in ten (38%) voters say it will have “no impact at all” on their decision to vote. The expiration of the tax credits is a stronger motivator for Democratic voters and independent voters than for Republican voters. About eight in ten Democratic and two-thirds of independent voters say it will impact their voting behavior, compared to about four in ten Republican voters.

This KFF Health Tracking Poll/KFF Tracking Poll on Health Information and Trust was designed and analyzed by public opinion researchers at KFF. The survey was conducted January 13-20, 2026, online and by telephone among a nationally representative sample of 1,426 U.S. adults in English (n=1,355) and in Spanish (n=71). The sample includes 1,028 adults (n=60 in Spanish) reached through the SSRS Opinion Panel either online (n= 1,003) or over the phone (n=25). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails.

Another 398 (n=11 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 149 were interviewed by phone and 249 were invited to the web survey via short message service (SMS).

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail or an electronic gift card incentive. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, 2 cases was removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2025 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.