Many Americans 'Likely' to Be Without Health Insurance if Premiums Double

A recent survey indicates that a large portion of Americans would consider dropping their health insurance if monthly premiums were to increase substantially. As Congress debates potential legislation to extend Affordable Care Act (ACA) subsidies, many individuals are already facing significant premium hikes for 2026.

The ACA subsidies currently help millions afford coverage through the Marketplace, but they are scheduled to expire at the end of 2025 unless renewed. Research from the non-profit organization KFF suggests that without these subsidies, premiums could more than double, prompting many of the 22 million recipients to contemplate going without insurance.

Financial Strain on Marketplace Enrollees

A KFF survey of 1,350 U.S. adults, conducted on December 4, found that over half of respondents would be likely to drop coverage if premiums doubled. Specifically, 25% said they would be very likely and 27% somewhat likely to forgo insurance. For respondents who currently do not pay premiums, the survey asked how they would respond to a $50 monthly cost.

Many are considering cheaper Marketplace plans with higher deductibles and co-pays, with 32% very likely and 38% somewhat likely to choose this route. Other options include seeking a new job that offers insurance (44%) or maintaining their current plan despite the higher cost (40%).

Regional and Political Differences

Survey results show that those living in states with Republican governors are more inclined to drop coverage (28%) compared to those in Democratic-led states (21%). Residents in states without expanded Medicaid are also more likely to forgo insurance (31% versus 20% in expansion states).

A 60-year-old Republican woman shared her experience: her premiums rose from $0 to over $600 for 2026. She plans to keep coverage for her husband while dropping her own to manage costs. Across the survey, many already find it difficult to pay for healthcare. Nearly 23% report it is very difficult and 39% somewhat difficult to cover out-of-pocket medical costs. Similarly, 16% find premiums very difficult and 35% somewhat difficult to afford.

Struggling to Cover Basic Expenses

Between 36% and 50% of respondents struggle to pay for rent, groceries, utilities, fuel, and medications. One 39-year-old woman in Oklahoma noted that her subsidized premium rose from $25 to $300, making it unaffordable alongside rising living costs. Over 58% of Marketplace enrollees said a $300 annual increase would significantly disrupt their finances, rising to 67% among those aged 18-29. Additionally, 53% stated it would be very hard to find an affordable alternative insurance plan.

Strong Support for Extending ACA Subsidies

Support for extending premium tax credits is widespread across political lines: 95% of Democrats, 84% of independents, and 72% of Republicans enrolled in Marketplace plans favor renewal. Despite this, confidence in political leaders to address insurance costs is low. Only 25% trust Democrats in Congress, while 42% lack confidence in Congressional Republicans and 45% in former President Trump.

Analysis: Rising Premiums Threaten Health Coverage for Millions

The latest survey underscores the precarious position of millions of Americans reliant on ACA Marketplace subsidies. As premiums are projected to increase substantially in 2026, more than half of current enrollees indicate they might forgo coverage if costs double. This highlights the fragility of the current system and the direct impact of subsidy expiration.

Financial pressures are already severe. A significant portion of respondents struggle to cover basic living expenses alongside medical costs. Many are considering cheaper plans with higher deductibles, seeking employer-sponsored insurance, or maintaining coverage despite financial strain. Regional and political differences are notable, with residents in Republican-led states and non-expansion Medicaid states more likely to drop insurance.

Public support for extending ACA subsidies remains strong across party lines, yet trust in political leaders to act is low. With 22 million Americans at risk of losing affordable coverage, timely legislative action on premium tax credits appears essential to prevent a substantial increase in uninsured rates.

Sources:

• Many Americans ‘Likely’ to Go Without Health Insurance If Their Premiums Double