Lately, Priscilla Brown has had to choose between properly managing her Type 2 diabetes and affording other necessities, like gas in her car. Some days, she takes half or a third of her prescribed insulin dose — just to stretch it out longer."Sometimes I don't even take my medicine," said the 48-year-old truck dispatcher in Orlando, Florida. "It's so much with insurance, it's crazy."About 8 in 10 Americans, like Brown, who re-enrolled in Affordable Care Act marketplace coverage say their health care costs are higher this year, including about half who say their costs are "a lot" higher, according to a new survey from the health care research nonprofit KFF. A main reason for increased costs was the Dec. 31 expiration of enhanced tax credits that had offset premiums for most enrollees.For Brown and others, those spiking costs are having real impacts on daily life. Of the 1,117 Americans surveyed who had ACA marketplace coverage in 2025, including those who dropped coverage or changed plans, about 55% said they're planning to deal with health care costs by cutting spending on food and other basic household needs.Democrats in Congress last year had fought to keep the COVID-era subsidies but faced pushback from Republican leadership. In January, momentum toward a bipartisan compromise fell apart — leaving some 23 million ACA enrollees without relief as they faced higher premiums or made tough decisions to disenroll or downgrade plans.The new poll, which was conducted in February and March and followed up with respondents from a survey conducted last year to learn how they're grappling with health insurance now, offers a glimpse at how Congress' unresolved fight continues to strain regular Americans — even as many federal lawmakers have, at least for the moment, turned to other priorities.Many ACA enrollees are anxious about medical costsLast year, Brown paid zero dollars toward her health insurance premiums. This year, her new plan costs $17 a month — and has a higher deductible.Brown said she learned this week that her new refill of medicine was going to cost more than $150 and "almost passed out." She filled her car with only half the gas she needed, knowing she'd need money for the medications.Anxieties about unexpected medical costs are acute, the poll shows. About three-quarters of people who had ACA insurance last year now say they are "very" or "somewhat" worried about paying for emergency care or hospitalization, while about half said the same about routine medical visits or prescription drugs.Some enrollees switch to lower-tier plans, while others drop coverage entirelyMost of last year's enrollees, about 7 in 10, stayed on ACA health insurance — but that includes about 3 in 10 who changed plans within the marketplace. Meanwhile, about 2 in 10 became eligible for coverage through their employer, Medicare or Medicaid or purchased insurance outside of the ACA marketplace, which tends to be less comprehensive.About 1 in 10 of last year's enrollees said they dropped coverage altogether and are now uninsured, the poll shows. Eric LeVasseur, a 63-year-old software developer in Seal Beach, California, was part of that group. He said when he saw his mid-tier, silver-level plan was going to nearly triple to $1,200 per month, "it was not something my budget could absorb."Many enrollees blame health insurance companies and politiciansAbout 7 in 10 returning ACA enrollees facing higher costs say they blame health insurance companies "a lot," while just over half put "a lot" of blame on Republican lawmakers, President Donald Trump and pharmaceutical companies. About one-third blamed Democrats in Congress or hospitals "a lot," while about 1 in 10 placed this level of blame on doctors or employers.Respondents who identified with a political party and saw costs rise overwhelmingly blamed the opposing party's lawmakers "a lot."James Mako, an engineer in Boca Raton, Florida, and a political independent, said he blames the Republican Party. His $500-per-month premiums were poised to double this year for his silver-level ACA health plan. So, he downgraded to a bronze-level plan with a higher deductible.Mako said he's not convinced by the ideas Republicans have floated to fix the problem, like funneling money into health savings accounts."I think they're just sales gimmicks," he said. "The subsidies should be back."—The KFF poll was conducted Feb. 12-Mar. 2, 2026, among 1,117 U.S. adults who had Marketplace insurance in 2025, using a sample drawn from two probability-based panels. All of the respondents participated in the 2025 KFF Marketplace Survey and were recontacted for the new survey. The margin of sampling error for the full sample is plus or minus 3.8 percentage points.