Millions of Americans are on the brink of a health care crisis as enhanced Affordable Care Act (ACA) subsidies are set to expire at the end of 2025, driving up insurance premiums by as much as 75% or more in 2026. A new survey reveals that nearly half of U.S. adults fear they won’t be able to afford health care next year, with many already contemplating skipping doctor visits or treatments due to skyrocketing costs.
The poll, conducted by the Kaiser Family Foundation (KFF), underscores a growing anxiety over Health care costs amid political gridlock in Washington. With open enrollment for 2026 plans beginning in November, families across the country are scrambling to understand the implications of the subsidy cliff. Enhanced ACA subsidies, first introduced during the COVID-19 pandemic and extended through the Inflation Reduction Act, have kept premiums affordable for over 20 million people. Their lapse could force millions off coverage or into financial ruin.
Survey Highlights Widespread Worry Over Insurance Premium Hikes
The KFF survey, released this week, paints a stark picture of public sentiment. Among 1,200 U.S. adults polled, 48% expressed significant concern that they or their family members would struggle to pay for health care in 2026. This marks a sharp increase from pre-pandemic levels, where affordability issues were already prominent but subsidized by federal aid.
Key findings from the survey include:
- 37% of respondents said they might delay or skip medical care due to affordability fears.
- Low-income households, earning less than $50,000 annually, reported the highest anxiety at 62%.
- Even middle-class families, previously shielded by subsidies, anticipate average annual premium increases of $2,400 for a family of four.
“We’re hearing from people who are terrified,” said KFF health policy analyst Cynthia Cox. “These subsidies have been a lifeline, reducing out-of-pocket costs dramatically. Without them, Health care costs could become prohibitive for working families.”
The survey also noted partisan divides: 65% of Democrats support extending the subsidies, compared to just 28% of Republicans, reflecting broader debates over government intervention in health care.
ACA Subsidies Expiration Triggers Massive Premium Projections
The enhanced ACA subsidies, enacted under the 2021 American Rescue Plan and prolonged by the 2022 Inflation Reduction Act, cap premium contributions at 8.5% of household income for most enrollees. They expire on December 31, 2025, just weeks away from the critical open enrollment period starting November 1.
Without extension, analysts predict insurance premiums will surge dramatically. The Congressional Budget Office (CBO) estimates that 4 million people could lose coverage entirely, while others face unsubsidized rates. For example:
| State | Average 2025 Subsidized Premium (Family) | Projected 2026 Unsubsidized Premium | Increase |
|---|---|---|---|
| Texas | $450/month | $1,200/month | 167% |
| Florida | $520/month | $1,350/month | 160% |
| California | $380/month | $850/month | 124% |
| National Avg. | $500/month | $1,100/month | 120% |
These projections come from Wakely, a leading health insurance consulting firm, which modeled scenarios based on current Marketplace data. In states without expanded Medicaid, like Texas and Florida, the impact will be most severe, potentially overwhelming emergency rooms with uninsured patients.
Americans Share Heartbreaking Stories of Cost-Driven Sacrifices
Behind the numbers are real lives hanging in the balance. In Ohio, single mother Maria Gonzalez, 34, relies on ACA coverage for her daughter’s asthma treatments. “Right now, my premium is $120 a month after subsidies,” she told reporters. “Without them, it’ll jump to $450. That’s my rent money. I’ll have to choose between her inhalers and groceries.”
Similar tales emerge nationwide. A survey by the American Hospital Association found that 22% of Marketplace enrollees are considering dropping coverage altogether. Veterans, gig workers, and early retirees—who make up a large swath of the 21 million ACA enrollees—are particularly vulnerable.
Dr. Emily Chen, a primary care physician in Georgia, reports a surge in patients rationing medications. “I’ve had people skip cancer screenings because they fear the bill,” she said. “This isn’t just about premiums; it’s about preventable deaths from untreated conditions.”
In rural areas, where Marketplace options are limited, Health care costs could force clinic closures. The National Rural Health Association warns of a “perfect storm” as premiums rise alongside provider shortages.
Political Battle Intensifies Over Subsidy Extension
As the deadline approaches, Capitol Hill is abuzz with proposals to extend the ACA subsidies. Democrats, led by Senate Majority Leader Chuck Schumer, have introduced the “Affordable Care Act Extension Act,” aiming to make enhancements permanent at a cost of $335 billion over 10 years, per CBO estimates.
Republicans counter with market-based reforms, including expanding health savings accounts (HSAs) and short-term plans. House Speaker Mike Johnson stated, “We can’t keep throwing money at a broken system. True affordability comes from competition, not endless subsidies.”
Industry groups are lobbying hard. America’s Health Insurance Plans (AHIP) urges bipartisan action, warning that premium hikes could add $100 billion to federal spending via uncompensated care. Meanwhile, patient advocates like Families USA rally for immediate relief.
State-level responses vary: California and New York are exploring state-funded subsidies, while red states like Tennessee resist, citing fiscal burdens.
Future Outlook: Enrollment Chaos and Policy Pathways Ahead
With open enrollment looming, HealthCare.gov anticipates a 30% drop in sign-ups if subsidies lapse, per CMS projections. Insurers are already adjusting rates, with some pulling out of high-risk markets.
Experts recommend immediate action: Shop early during open enrollment, explore employer plans or Medicaid eligibility, and contact congressional representatives. Non-profits like Enroll America are ramping up free navigator services to guide consumers through turbulent waters.
Long-term, the subsidy saga highlights deeper flaws in the U.S. health system. Policymakers face a pivotal choice: Extend aid temporarily, overhaul the ACA, or pursue universal coverage alternatives. As one KFF expert put it, “Affordability isn’t a partisan issue—it’s a human one.” Failure to act could redefine health care access for a generation, pushing health care costs to unsustainable levels and eroding public trust in the system.
Stay tuned for updates as Congress debates, and consumers brace for what’s next in this unfolding drama.
