Jessica Chamberlain is 43 years old, a single mother of two, and works in probation in Illinois. Last year she paid $59.67 a month for health insurance through the ACA Marketplace. This year the same coverage costs her nearly $100 a month.
She dropped it. She is now uninsured. She is also diabetic.
“What do I sacrifice to pay for health insurance?” she told ABC News. “What do I have to sacrifice to keep my medications and my health afloat?”
She is not an outlier. She is a data point in a crisis that a major new survey published Thursday is finally putting hard numbers to.
What the KFF Survey Found
The Kaiser Family Foundation surveyed 1,117 Americans who had ACA Marketplace coverage in 2025. The results, published Thursday, are the first comprehensive measure of what the expiration of enhanced premium tax credits has actually done to real people.
Nine percent of those surveyed, roughly one in ten, dropped their coverage entirely and are now uninsured.
Another 17% said they are not confident they will be able to afford their premiums for the full year. That means nearly one in three ACA enrollees is either already uninsured or at serious risk of becoming uninsured before 2026 is over.
Eighty percent of returning enrollees said their health care costs are higher than last year. Fifty-one percent said costs are “a lot higher.” Fifty-five percent said they have cut or plan to cut spending on food and other basic household expenses to afford health care.
Forty-three percent are trying to find a second job or work more hours. Twenty-three percent are skipping or delaying paying other bills. Twenty-one percent are taking out loans or increasing their credit card debt. All to pay for health insurance.
A 63-year-old man in California, now uninsured, told KFF: “The end of ACA subsidies caused a huge increase in premiums, the cost of which I could not afford.” That’s the whole story in one sentence.
How Premiums Doubled Overnight
The enhanced premium tax credits that helped 22 million Americans afford ACA coverage expired at the end of 2025. Congress passed them during COVID as a temporary measure. They were extended twice. Then they expired.
When they went away, the average out-of-pocket premium for ACA enrollees increased by more than 75%. Not 10%. Not 20%. Seventy-five percent. Overnight.
Holly Weir is 26, lives in Ohio, and is a thyroid cancer survivor who sees an oncologist every two months. Last year she paid $30 a month for health insurance. This year the same plan costs $177 a month. “I got the bill in the mail and I was like, ‘[Expletive]!'” she told ABC News. She has cancelled her insurance and applied for Medicaid. She is waiting to hear back.
Kelly Rose of Florida saw her monthly ACA premium jump to $1,700. “It’s more than my mortgage,” she told the Wall Street Journal.
She missed the deadline to enroll in her employer’s plan because she had planned to keep her ACA coverage. She is now uninsured, buying her asthma medication from a Canadian pharmacy because the US price is $800 a month.
These are not edge cases. These are the kinds of stories in every state, in every income bracket just above Medicaid eligibility, playing out simultaneously across the country right now.
The Insurance Industry Saw This Coming
Here is something that doesn’t get said plainly enough: the insurance companies knew this would happen. They planned for it.
KFF notes that insurers raised premiums beyond underlying cost increases specifically because they expected healthier adults to drop coverage once subsidies expired, leaving a sicker pool of enrollees behind. When healthier people leave, premiums rise further for those who stay.
When premiums rise further, more people leave. This is called adverse selection and it is the death spiral that the ACA was specifically designed to prevent. The enhanced subsidies were what prevented it. When they expired, the spiral began.
CVS Health’s Aetna didn’t wait to see how it plays out. It dropped out of the ACA Marketplace entirely. When one of the country’s largest insurers concludes the market is no longer worth participating in, it is not a good sign for the people who depend on that market.
The Policy Decision That Caused This
The expiration of enhanced subsidies was not an accident. It was a choice.
During last fall’s record government shutdown, Democrats pushed to extend the enhanced premium tax credits. Most Republicans voted against it.
The shutdown ended without an extension. The subsidies expired December 31, 2025. Premiums jumped January 1, 2026. KFF published the first major survey of the damage on March 19, 2026.
KFF’s own polling found that independents, when asked who bears “a lot” of blame for the coverage losses, pointed to congressional Republicans at 56% and Trump at 58%. Congressional Democrats received 28%. This is not a partisan framing from KFF. It is what survey respondents said when asked directly.
Meanwhile, the One Big Beautiful Bill Act signed in July 2025 introduced Medicaid work requirements and tightened eligibility rules. The Medicaid cuts of nearly $1 trillion over ten years are still coming.
The Title X reproductive health funding for clinics runs out March 31. The NIH grant crisis is hollowing out biomedical research. The ACA subsidy expiration is uninsuring millions of people right now.
These are not separate stories. They are one story. The systematic withdrawal of the federal government from its role in American health care, moving on multiple fronts at once, faster than the public can track any single piece of it.
Who Gets Hurt First
The KFF survey is specific about who is bearing the worst of the cost increases.
People with chronic conditions. People in the coverage gap, who earn too much for Medicaid but not enough to afford full-price premiums.
Single parents. People between jobs. People like Jessica Chamberlain, who works, pays taxes, raises her kids alone, and has now made the rational economic calculation that health insurance is something she cannot afford.
The clinical reality of this is something physicians are already seeing. Brian Outland of the American College of Physicians described it plainly: “Physicians love their patients. Just not being able to see them because they don’t have insurance is quite heartbreaking.”
Uninsured patients delay care. They skip preventive screenings. They wait until conditions become emergencies. Emergencies cost more to treat than prevention.
Uncompensated care costs get shifted to insured patients through higher premiums. Premiums rise. More people drop coverage. The spiral deepens.
What Comes Next
The KFF survey was conducted between February and early March. It captures three months of damage. The full year hasn’t happened yet.
Seventeen percent of returning enrollees said they are not confident they can afford their premiums through December. Those people are not counted in the nine percent who have already dropped coverage. They are the next wave.
Marketplace enrollees who haven’t paid their first 2026 premium have until the end of March before their coverage is retroactively terminated. That deadline is ten days away.
There is no legislation currently moving in Congress to restore the enhanced subsidies. There is no plan being discussed publicly. The ACA Marketplace will lose more enrollees this year.
The question is how many, and whether any of them will get the care they need before the cost of waiting becomes something worse than a bill.
Jessica Chamberlain is still in Illinois. Still uninsured. Still diabetic. Still hoping she can find another plan before something happens that she can’t manage without insurance.
“This is destroying people who have pre-existing conditions,” she said. “It is affecting people, especially single moms. We’re just trying to live.”
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