Despite some last minute drama, Congress has recessed for the year without passing a bill extending the expiring enhanced Affordable Care Act (ACA) tax credits. While the House is now expected to consider an extension in January, the vote would come too late for many ACA enrollees who are likely to receive their first bills reflecting an average 114% increase in premium payments.
The expiration of enhanced ACA tax credits is reshaping coverage decisions for Marketplace enrollees, and in a recent KFF survey, Marketplace enrollees told us how rising premium payments could affect their decisions about continuing coverage, how they are balancing their expenses, and how it could impact future voting decisions.
According to the survey, a quarter of Marketplace enrollees say that if their monthly premium increases, they would be “very likely” to go without health insurance. A 20-year-old man in Texas reported that this increase would be unaffordable and therefore he is considering going without coverage. “The cost nearly tripled. I can no longer afford to have my health insurance without putting my other finances in jeopardy.” Health experts warn that if younger, generally healthier enrollees drop coverage, it could raise costs for those who remain insured, while also increasing the number of uninsured patients seeking care from hospitals and health systems.
A few enrollees feel fortunate that recent life changes allow them to get coverage elsewhere. A 64-year-old woman in South Dakota says that she will turn 65 soon and become eligible for Medicare, while a 63-year-old woman in New Hampshire reports, “I just got married and will be eligible through my partners plan 12/01. Thank goodness!!” But the vast majority (88%) say that if their monthly premium payments become unaffordable, it would be difficult for them to find another source of coverage they could afford.
This is the case with a 58-year-old woman in California who expressed concern about how to navigate the cost increase. She is looking for a new job that would provide health coverage saying “Hopefully I will have a new job and it will provide insurance for me. If not, I won’t be able to afford insurance and will be in BIG trouble.” A 37-year-old man in Texas worries about other costs, saying that he “can’t afford groceries for my children.”
It remains unclear what will happen to the enhanced tax credits in 2026, but in the meantime ACA enrollees will be facing difficult decisions about what to do for health coverage, and those decisions may impact future voting behavior. A 29-year-old woman in Texas offered the following: “Currently, my monthly payment is around $30 with a deductible of $300. As of next year, if I get a premium of $0, my deductible will be $10,000. If I have a low deductible, my monthly premium with be $300+. I simply cannot afford it.” As a MAGA supporter, she said that if Congress doesn’t extend the tax credits, it will have a major impact on her decision to vote in 2026.