New ACA affordability tradeoffs are forcing many Americans to rethink how they pay for everyday essentials. A new KFF poll, highlighted by PBS NewsHour, found that about 8 in 10 people who re-enrolled in Affordable Care Act marketplace coverage say their health care costs are higher in 2026 than they were last year.
More than half said they are already cutting back, or expect to cut back, on food, clothing, and other household basics to keep up with those expenses. The poll shows that health coverage costs are no longer just a budget issue for doctor visits. They are now affecting what families can afford at home.
The main driver is the expiration of enhanced federal ACA subsidies that had lowered premiums for many marketplace enrollees. As those subsidies disappeared, many households faced higher monthly premiums, larger deductibles, or steeper out-of-pocket costs.
Many Enrollees Fear They Cannot Afford Care
The KFF survey found that cost anxiety extends beyond premiums. About three-quarters of respondents said they worry about affording emergency or hospital care. Nearly half said they are concerned about paying for routine care, and 45% said prescription drug costs are a major worry.
That kind of pressure can change how people use the health system. When coverage becomes harder to maintain, and out-of-pocket costs keep climbing, families may delay care, switch to less comprehensive plans, or drop insurance entirely. The poll found that roughly 1 in 10 former ACA enrollees are now uninsured.
Another 17% of those who still have ACA coverage said they are not confident they will be able to afford their premiums for the full year. That signals more possible coverage losses ahead if costs keep rising.
Coverage Costs Are Reaching Beyond Medical Bills
These ACA affordability trade-offs are part of a broader strain on health care costs across the country. Recent Gallup-West Health data showed that one-third of Americans cut other spending in 2025 to cover medical costs, including food, utilities, and transportation.
For ACA enrollees, the squeeze may be especially sharp because marketplace plans often expose people to both premium increases and higher deductibles simultaneously. That means families can pay more each month while still worrying about what care will cost when they actually use it. This is an inference based on the KFF findings about rising premiums, deductibles, and other cost-sharing.
The public health concern is obvious. When people cut food spending to keep insurance, they may protect coverage in the short term while creating other health risks at home. That tension shows how closely health insurance affordability is tied to nutrition, stress, and daily well-being. This is an inference, but it follows directly from the poll’s finding that food is one of the first areas households plan to cut.
A Warning Sign for Health Policy
The poll suggests that affordability, not just access, is becoming the central ACA problem in 2026. Millions may still technically have the option to buy marketplace coverage, but rising costs are making that option harder to sustain.
That matters because insurance only works as a health protection tool when people can keep it and use it. If families must sacrifice food and other essentials just to stay enrolled, policymakers may face growing pressure to revisit subsidies, cost-sharing rules, and marketplace support. This is a reasoned conclusion based on the poll’s affordability findings and recent enrollment declines after subsidy expiration.
For now, the strongest message from the survey is simple: ACA affordability tradeoffs are no longer abstract. They are showing up in kitchens, grocery budgets, and household decisions across the country.