---
type: source
title: "KFF Survey: 51% of ACA Marketplace Enrollees Report Health Costs 'A Lot Higher' After Enhanced Tax Credit Expiration"
author: "KFF Health News"
url: https://www.kff.org/health-reform/report/cost-concerns-coverage-changes-a-follow-up-survey-of-aca-marketplace-enrollees/
date: 2026-03-01
domain: health
secondary_domains: []
format: survey
status: processed
priority: high
tags: [aca, marketplace, premium-tax-credits, coverage-loss, cost-burden, obbba, health-insurance, compounding-failure]
---

## Content

KFF survey of 2025 ACA Marketplace enrollees following the expiration of enhanced premium tax credits (enacted as pandemic relief, extended through 2025, now expired for 2026 plan year).

**Key findings:**
- 51% of returning marketplace enrollees say health care costs are "a lot higher" following the expiration of enhanced premium tax credits
- Most enrollees anticipate reducing household expenses (food, housing, other necessities) to maintain coverage
- Many are reconsidering whether to maintain coverage

**Context:**
Enhanced premium tax credits (APTCs) were enacted in the American Rescue Plan Act (2021) and extended through the Inflation Reduction Act (2022). They provided substantially larger subsidies for marketplace plan premiums than baseline ACA subsidies. The OBBBA (One Big Beautiful Bill Act, signed July 4, 2025) did not extend the enhanced credits; they expired at the end of the 2025 plan year.

**The double coverage compression:**
This creates a second pathway to coverage loss simultaneous with OBBBA Medicaid cuts:
- OBBBA pathway: 10M Medicaid losses by 2034 (work requirements effective Dec 31, 2026; semi-annual redeterminations effective Oct 1, 2026)
- APTC expiry pathway: Marketplace enrollees now paying higher premiums → some will drop coverage → shift to uninsured
- The populations are distinct: Medicaid cuts hit income ≤138% FPL; marketplace APTC hits 138-400% FPL
- Together, they compress coverage options across the entire low-to-moderate income spectrum

Drew Altman (KFF): Health care costs remain a top voter concern even amid War in Iran news cycle; geopolitical attention displacement may reduce scrutiny of OBBBA implementation.

## Agent Notes
**Why this matters:** This is a SECOND structural coverage loss mechanism that the existing OBBBA archives don't capture. The four OBBBA archives (KFF/CBO, Annals, VBC stability, Fierce) all focus on the Medicaid pathway. The enhanced APTC expiration creates a parallel coverage erosion at higher income levels. The combined effect is simultaneous coverage compression across the income distribution, not just Medicaid.

**What surprised me:** The geopolitical context — Drew Altman specifically flagged that the War in Iran may temporarily displace healthcare cost concerns from public attention. OBBBA implementation is proceeding while political attention is elsewhere. This has historical parallels: major policy implementations often advance under geopolitical distraction.

**What I expected but didn't find:** Specific enrollment data showing how many people are dropping marketplace coverage in early 2026. The KFF article describes the survey but likely doesn't have enrollment decline numbers yet (those would lag the coverage decision).

**KB connections:**
- Extends OBBBA Annals archive (16,000 deaths) — the Gaffney et al. study only modeled Medicaid pathways; marketplace coverage loss adds to the mortality count
- Strengthens Belief 1 "systematic failure compounding": two independent coverage loss mechanisms operating simultaneously
- Connects to VBC stability archive: marketplace enrollees are often enrolled in ACA marketplace VBC plans — their disenrollment also fragments VBC prevention investment

**Extraction hints:**
- PRIMARY CLAIM: "The expiration of enhanced ACA premium tax credits in 2026 creates a second simultaneous coverage loss pathway above the Medicaid income threshold, compressing coverage options across the entire low-to-moderate income spectrum in parallel with OBBBA Medicaid cuts"
- Supporting data: 51% of enrollees report "a lot higher" costs (KFF survey, March 2026)
- DO NOT conflate with the OBBBA Medicaid claim — these are distinct mechanisms affecting distinct populations

**Context:** From KFF homepage, March 2026. Report title: "Cost Concerns, Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees." The enhanced APTC expiration is distinct from the OBBBA's core Medicaid cuts, but occurs simultaneously, creating compounding effects across income levels.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]
WHY ARCHIVED: Documents a second simultaneous coverage compression pathway (marketplace APTC expiry) not captured in existing OBBBA archives — completes the picture of how 2026 represents a double hit to US health coverage across the income distribution
EXTRACTION HINT: Extract as a SEPARATE claim from the OBBBA Medicaid claim. The income levels are different (138-400% FPL vs. <138% FPL), the mechanism is different (premium burden vs. eligibility loss), and the policy source is different (APTC expiry vs. OBBBA). The synthesis value is in showing that TWO independent 2026 policy changes attack coverage simultaneously across the income spectrum.
