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COSTS and Affordability

A Preview of the Role Health Care May Play in the 2026 Election

Ahead of the 2026 midterm elections, this KFF issue brief examines the role health care has played in previous elections and what that may suggest about its potential role in 2026. KFF polls have consistently found that the cost of health care is an important part of voters’ economic concerns.

Affordable care act

ACA Marketplace Survey Feature Image - Website

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

This KFF survey is a follow-up survey of adults who had ACA Marketplace insurance in 2025. The survey examines the cost concerns and coverage changes of Marketplace enrollees following the end of the enhanced premium tax credits and finds that half of returning enrollees say their health care costs are “a lot higher” and most expect to cut back on basic household expenses to afford coverage.

Health System Tracker

What Are the Recent Trends in Employer-Based Health Coverage? Employer-sponsored health insurance is the largest source of health coverage for people under 65, but its reach is uneven.

How Does U.S. Life Expectancy Compare to Other Countries? The life expectancy gap between the U.S. and peer countries decreased from 4.1 years in 2023 to 3.7 years in 2024 as U.S. mortality dropped.

How Does Cost Affect Access to Health Care? In 2024, about 1 in 6 adults reported delaying or not getting healthcare due to cost, including medical or mental health care.

How Does Health Spending in the U.S. Compare to Other Countries? While the U.S. still spends the most in total dollars, eight OECD nations had a higher percentage increase in per-person health spending in 2024.

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  • Section 12: Employer Opinions and Health Management Programs

    Report

    Exhibit 12.1 Exhibit 12.6 Exhibit 12.2 Exhibit 12.7 Exhibit 12.3 Exhibit 12.8 Exhibit 12.4 Exhibit 12.9 Exhibit 12.5   12 Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. Health Insurance Coverage in America, 2002 Data Update, December 2003.

  • Section 11: Retiree Health Benefits

    Report

    Exhibit 11.1 Exhibit 11.4 Exhibit 11.2 Exhibit 11.5 Exhibit 11.3   11 Twenty-eight percent of Medicare beneficiaries receive prescription drug coverage from an employer, a far higher number than receive coverage through a Medicare HMO (15%), Medigap (7%) or Medicaid (10%). Laschober et. al., Health Affairs, February 2002.

  • Section 10: Plan Funding

    Report

    Exhibit 10.1 Exhibit 10.5 Exhibit 10.2 Exhibit 10.6 Exhibit 10.3 Exhibit 10.7 Exhibit 10.4   10 A self-funded plan is one in which the employer assumes direct responsibility for the costs of enrollees’ medical claims. Employers sponsoring self-funded plans typically contract with a third-party administrator or insurer to provide administrative services for the self-funded plan.

  • Section 9: Prescription Drugs and Mental Health Benefits

    Report

    Exhibit 9.1 Exhibit 9.5 Exhibit 9.2 Exhibit 9.6 Exhibit 9.3 Exhibit 9.7 Exhibit 9.4 Exhibit 9.8 9 There are fewer observations for estimating the average copayment for four-tier drugs compared to other drug types.

  • Section 6: Employee Contributions for Premiums

    Report

    Exhibit 6.1 Exhibit 6.9 Exhibit 6.2 Exhibit 6.10 Exhibit 6.3 Exhibit 6.11 Exhibit 6.4 Exhibit 6.12 Exhibit 6.5 Exhibit 6.13 Exhibit 6.6 Exhibit 6.14 Exhibit 6.7 Exhibit 6.15 Exhibit 6.

  • Section 5: Market Shares of Health Plans

    Report

    The distribution of enrollment among types of health plans has remained fairly constant over the past several years. The majority of covered workers are enrolled in PPO plans (55%), followed by HMO plans (25%) (Exhibit 5.1).

  • Section 4: Health Insurance Choice

    Report

    Exhibit 4.1 Exhibit 4.6 Exhibit 4.2 Exhibit 4.7 Exhibit 4.3 Exhibit 4.8 Exhibit 4.4 Exhibit 4.9 Exhibit 4.5 Exhibit 4.10 5Survey respondents were asked whether the firm offers a personal or health savings account, including a Health Reimbursement Arrangement (HRA) or other type of health savings account option.