Priscilla Brown, a 48-year-old truck dispatcher in Orlando, has been forced to ration her insulin by taking half or a third of her prescribed dose as health care costs surge following the expiration of enhanced Affordable Care Act subsidies. About 8 in 10 Americans who re-enrolled in ACA marketplace coverage report higher health care costs this year, with about half saying their costs are “a lot” higher, according to a new survey from the health care research nonprofit KFF. Brown’s struggle illustrates the real-world impact of Congress’ failure to extend COVID-era subsidies that expired Dec. 31.
“Sometimes I don’t even take my medicine,” said Brown, who manages Type 2 diabetes. “It’s so much with insurance, it’s crazy.” Her health insurance premiums jumped from zero dollars last year to $17 a month this year under her new plan. The survey of 1,117 Americans with ACA marketplace coverage in 2025 reveals the widespread financial strain facing enrollees across the country.
About 55% of surveyed ACA enrollees said they plan to deal with rising health care costs by cutting spending on food and other basic household needs. The enhanced tax credits that had offset premiums for most enrollees were a key component of pandemic-era relief measures. Democrats in Congress fought to keep the subsidies but faced pushback from Republican leadership, leaving approximately 23 million ACA enrollees without relief as they confronted higher premiums or made difficult decisions to disenroll or downgrade plans.
The subsidy expiration has created a cascade of difficult choices for Florida residents and Americans nationwide who rely on ACA marketplace coverage. In January, momentum toward a bipartisan compromise to restore the enhanced subsidies fell apart, forcing enrollees like Brown to choose between proper medical care and other necessities like gas for her car. The KFF poll, conducted in February and March, followed up with respondents from a previous survey to track how they’re managing health insurance challenges.
Many ACA enrollees are experiencing anxiety about mounting medical costs as federal lawmakers have shifted focus to other priorities. The survey data shows the ongoing strain on regular Americans from Congress’ unresolved fight over health care subsidies. Brown’s situation reflects a broader pattern where patients are making dangerous medical decisions based on financial constraints rather than clinical needs.
The enhanced tax credits were originally implemented as part of COVID-19 relief efforts and had provided significant premium reductions for millions of Americans. Without these subsidies, many enrollees face the choice between maintaining comprehensive coverage at higher costs or switching to plans with reduced benefits and higher deductibles. The impact extends beyond individual health outcomes to affect household budgets and spending on basic necessities.
Congress has yet to announce any timeline for reconsidering enhanced ACA subsidies, leaving millions of Americans in financial uncertainty about their health care coverage for the remainder of 2025.