U.S. healthcare costs spike after ACA subsidy expire: KFF survey
CALIFORNIA, UNITED STATES — A sharp rise in healthcare costs following the expiration of Affordable Care Act (ACA) subsidies at the end of 2025 is leaving millions of Americans uninsured and straining providers across the United States, according to a new survey from KFF.
The survey found that one in 10 ACA enrollees in 2025 have lost coverage, while those who remain insured are facing significantly higher costs.
Half of marketplace enrollees said their healthcare expenses are “a lot higher” this year, underscoring the immediate impact of subsidy rollbacks on affordability and access.
Rising uninsured rates strain hospitals and care delivery
Healthcare providers are already feeling the ripple effects of coverage losses, particularly hospitals and safety-net systems that serve low-income populations.
As more patients become uninsured, providers face growing levels of uncompensated care, which can erode operating margins and limit investments in staffing and infrastructure.
The survey highlights that 80% of returning enrollees reported higher premiums, deductibles, or co-pays in 2026. At the same time, one in six enrollees said they are uncertain they can continue paying for coverage through the year.
Cost pressures are also reshaping patient behavior. A quarter of enrollees downgraded from Silver to Bronze plans, trading lower monthly premiums for higher out-of-pocket costs.
This shift is expected to delay care-seeking, as patients shoulder more upfront expenses before insurance coverage kicks in.
Financial anxiety is widespread. According to KFF, 73% of enrollees are “very worried” or “somewhat worried” about affording emergency care or hospitalizations, while nearly half report similar concerns over routine visits and prescription drugs.
Cost pressures drive operational shifts across health systems
For providers, these affordability challenges are translating into more complex revenue cycles and administrative burdens. As patients struggle to pay, hospitals and clinics must navigate higher bad debt, delayed reimbursements, and increased eligibility checks.
The survey found that 55% of enrollees are cutting back on food or basic household items to afford healthcare, rising to 62% among those with chronic conditions. Such trade-offs may lead to worsening health outcomes and increased demand for acute care services over time.
These pressures are prompting some health systems to explore cost-containment strategies, including outsourcing administrative functions such as billing, coding, and patient support services. By shifting non-clinical workloads to specialized partners, providers can reduce overhead while maintaining patient access and financial stability.
The policy backdrop remains uncertain. A government shutdown followed partisan disagreements over subsidy extensions, while Donald Trump has proposed an alternative “Great American Healthcare Plan” that would redirect funds directly to consumers, pending legislative approval.
As the U.S. healthcare system adjusts to the post-subsidy landscape, providers are bracing for sustained financial and operational challenges driven by rising costs and declining coverage.
