What ACA enrollees are cutting back on to afford health care, according to a new poll

A new KFF survey shows many Americans who had Affordable Care Act marketplace health insurance last year are struggling with high health costs

NEW YORK -- Lately, Priscilla Brown has had to choose between properly managing her Type 2 diabetes and affording other necessities, like gas in her car. Some days, she takes half or a third of her prescribed insulin dose — just to stretch it out longer.

“Sometimes I don’t even take my medicine,” said the 48-year-old truck dispatcher in Orlando, Florida. “It’s so much with insurance, it’s crazy.”

About 8 in 10 Americans, like Brown, who re-enrolled in Affordable Care Act marketplace coverage say their health care costs are higher this year, including about half who say their costs are “a lot” higher, according to a new survey from the health care research nonprofit KFF. A main reason for increased costs was the Dec. 31 expiration of enhanced tax credits that had offset premiums for most enrollees.

For Brown and others, those spiking costs are having real impacts on daily life. Of the 1,117 Americans surveyed who had ACA marketplace coverage in 2025, including those who dropped coverage or changed plans, about 55% said they’re planning to deal with health care costs by cutting spending on food and other basic household needs.

Democrats in Congress last year had fought to keep the COVID-era subsidies but faced pushback from Republican leadership. In January, momentum toward a bipartisan compromise fell apart — leaving some 23 million ACA enrollees without relief as they faced higher premiums or made tough decisions to disenroll or downgrade plans.