Health care costs top Americans' financial worries, KFF survey shows

When Americans sit down to worry about money, health insurance now ranks above everything else. Two-thirds of respondents in a January survey conducted by KFF, a major health policy research organization, said their anxiety about medical costs outweighs their concerns about paying for housing, food, utilities, or gas. The finding arrives at a moment of genuine hardship: Congress allowed enhanced premium subsidies for Affordable Care Act plans to expire at the end of 2025, leaving millions of enrollees facing sticker shock when renewal notices arrived with dramatically higher out-of-pocket costs.

The survey captured a nationally representative sample of 1,426 adults, with roughly equal numbers of registered Republicans, Democrats, and independents. The results paint a portrait of widespread financial strain. Thirty-two percent of respondents said they are "very worried" about affording health care for themselves and their families—a higher share than those naming groceries (24%), rent or mortgage (23%), utility bills (22%), or transportation costs (17%) as their primary concern. More than half reported that their health care costs rose over the past year, and at least one in five said those increases outpaced the rise in food or utility prices.

The political backdrop matters here. The enhanced subsidies were put in place in 2021 to help Americans weather pandemic-related economic disruption. Congress did not act to extend them, and their expiration triggered a cascade of consequences. Nationally, 23 million Americans enrolled in ACA coverage for 2026, representing a 5.5 percent decline from the previous year. In Florida, which had the highest state enrollment at 4.74 million in 2025, between 202,000 and 261,000 people dropped coverage—also a 5.5 percent decline, according to data from the Centers for Medicare and Medicaid Services released on January 28. Despite the drop, Florida retained the highest enrollment of any state.

The premium increases themselves have been severe. According to Florida Voices for Health, a nonprofit advocacy group, finalized rates for 2026 show premiums jumping between 23 and 40 percent. Scott Darius, the organization's executive director, characterized the 2026 jump as a "massive single year jump," noting that while rates have been climbing for years, this year's increase stands apart. "Making matters worse," he said, "Congress's decision to not extend the enhanced premium tax credits means hardworking Floridians will bear the brunt of these increases." At one point, KFF projected that 5 million Americans could become uninsured as a result of the subsidy expiration.

The political consensus around the subsidies' value is striking. When asked whether Congress did the right thing by not extending them, 67 percent of survey respondents said no—a view held by 89 percent of Democrats, 63 percent of Republicans, and 72 percent of independents. The breakdown suggests that frustration over rising health care costs transcends party lines, even as the broader political battle over economic policy contributed to a 43-day government shutdown last fall, the longest in U.S. history, which ended November 12.

The broader picture of financial anxiety extends beyond health insurance alone. Eighty-two percent of respondents said their cost of living has increased in the past year, with half reporting increases they characterized as substantial. Yet when forced to rank their worries, Americans consistently place health care at the top. The survey captures a moment when the abstract concern about medical costs has become concrete and immediate—renewal notices with higher premiums, enrollment deadlines that have already passed, and the question of whether coverage remains affordable at all.