As ACA Subsidies Expire, Health Costs Become Top Economic Concern for Voters Ahead of 2026 Midterms
Health care expenses have surged to the forefront of financial worries for American households, according to a recent poll by the Kaiser Family Foundation (KFF). The findings come just weeks after the expiration of enhanced Affordable Care Act (ACA) premium subsidies, signaling a potential impact on the upcoming 2026 midterm elections where control of Congress is at stake.
Survey Highlights Health Costs as Leading Financial Concern
The KFF poll, conducted from January 13 to January 20, 2026, surveyed 1,426 U.S. adults and revealed that 66% of respondents identified paying for health care as their primary financial worry. This concern outpaces other essential household expenses such as utilities, food, housing, and transportation. Notably, 32% of those surveyed said they are “very worried” about affording health care, while an additional 34% reported feeling “somewhat worried.”
Health care costs, as defined in the poll, encompass premiums for insurance coverage as well as out-of-pocket costs for medical visits and prescription medications. The significant public anxiety over these costs marks a shift from prior years when health care typically ranked as a secondary election issue.
Expiration of Enhanced ACA Subsidies Drives Premium Increases
The survey’s timing closely follows the end of enhanced federal premium subsidies for health plans purchased through the ACA marketplace. In 2025, over 22 million Americans—more than 90% of ACA enrollees—benefited from these expanded subsidies. KFF estimates that due to the expiration, the average individual’s monthly insurance premium will increase by over 100%, rising from $888 to $1,904 in 2026. Efforts by Democrats to extend these subsidies have largely been blocked by a Republican-majority Congress. This legislative stalemate has intensified affordability concerns among voters nationwide.
Rising Health Costs Felt Across Insurance Types and Parties
The poll also found growing health care cost concerns among people with employer-provided insurance, Medicare beneficiaries, and those purchasing coverage individually, many of whom rely on the ACA marketplace. Over 20% of respondents reported their health-related expenses have risen faster than other household costs like food or utilities in the past year.
Interestingly, worry over health care costs crosses political affiliations. While 71% of Democrats, 68% of independents, and 57% of Republicans expressed concern about paying for health care, the issue ranks as a top economic priority across the board. This bipartisan concern could shape voter behavior in the midterms.
Potential Electoral Implications with Democrats Holding Trust Advantage
Experts suggest that health care affordability may be a decisive factor in the 2026 midterm elections. Currently, Republicans control the White House, House, and Senate, but their slim margin in the House poses vulnerability.
According to KFF’s poll, 43% of voters say health care costs will heavily influence their choice of candidate. Moreover, Democrats hold a significant trust advantage over Republicans on key health care topics, including Medicaid’s future (43% vs. 25%), the ACA’s future (42% vs. 26%), Medicare’s future (40% vs. 26%), and addressing health care costs generally (40% vs. 27%).
The divide narrows on prescription drug pricing, an issue highlighted by President Donald Trump during his second term, where party trust is more evenly split. Among independents, a critical swing voting group, a substantial proportion still express distrust toward both parties on health care issues, signaling that affordability could remain a contested battleground topic.
Conclusion
As premium costs for health insurance double following the lapse of ACA subsidy enhancements, health care expenses have become the foremost economic worry for Americans. The bipartisan nature of this concern and Democrats’ current trust advantage could make health care a pivotal issue impacting congressional control in the 2026 midterm elections. Lawmakers and candidates will likely face intense scrutiny on their plans to alleviate health care affordability as voters prepare to head to the polls this November.