As ACA subsidies expire, voters cite health costs as major worry

Two out of 3 Americans surveyed, 66%, are worried about paying for health care — more than other household necessities such as utilities, food and groceries, housing and rent, and gasoline and transportation, according to a poll published Thursday by KFF, a nonpartisan health policy research group.

Health care includes the cost of health insurance and out-of-pocket expenses for office visits and prescription drugs, for example, according to KFF.

Among those concerned about health costs, 32% said they are “very worried” and 34% are “somewhat worried.” KFF surveyed 1,426 U.S. adults earlier this month.

“This could very well be the No. 1 issue for Americans at the polls in November,” said Nick Fabrizio, a health policy expert and associate teaching professor at Cornell University.

KFF conducted its poll from Jan. 13 to Jan. 20, just weeks after the expiration of enhanced federal premium subsidies for health insurance purchased on the Affordable Care Act marketplace.

About 22 million people — over 90% of ACA enrollees — received those enhanced subsidies in 2025. KFF estimates the average recipient will see their insurance premiums more than double this year as a result, to $1,904 per month from $888.

Democrats have pushed to extend the subsidies, but a majority of Republicans in Congress have so far stymied those efforts.

Health care typically ranks as a “second-tier election issue” in KFF’s regular polling, said Shannon Schumacher, a senior survey analyst.

But not this year, she said.

One likely reason: Most adults said their health-care costs have risen in the past year, including a “substantial share” — over 20% — who said their health costs have grown at a faster rate than other expenses like utilities or food, KFF found.

Majorities of people with employer-sponsored health insurance, Medicare and those who self-purchase their insurance, most of whom buy coverage on the ACA marketplace, report rising health costs over the past year, the poll found.

“Health care has always been top of mind and a top-five issue for Americans for the past 20 years,” Fabrizio said. “It only makes sense that concerns would rise to the top now, with all the attention to overall rising [health-care] cost.”

For example, 57% of people surveyed who identify as Republicans said they were worried about affording health-care costs, compared with 68% of independents and 71% of Democrats, according to KFF.

“What’s striking to me is that health-care costs are the top economic concern for everyone, whether Democrats, independents or Republicans,” Schumacher said.

The issue is shaping up to be a key factor in November’s midterm elections, experts said.

Republicans currently have a trifecta in the federal government, controlling the House of Representatives, Senate and White House. However, Republicans have a razor-thin majority in the House.

More than 4 in 10 voters surveyed — 43% — said the cost of health care will have a major impact on which candidate they support in the midterms, according to KFF.

They’re more split on which party would better address the cost of prescription drugs, however, an issue President Donald Trump has focused on during his second term, it said.

Importantly, while surveyed independents, a key voting bloc, said they generally trust Democrats more on most health-care issues, “sizeable shares of independent voters (between about one-third and four in ten) said they trust ‘neither’ party,” according to KFF’s survey analysis.

“This is still an issue that could be a battleground issue among independent voters,” Schumacher said.