The news: Most people who get their health coverage through the ACA marketplace think they’ll be unable to afford rising premiums if enhanced tax credits lapse, with many expecting to forgo insurance, per a November KFF survey of 1,350 US adults who purchase coverage on the ACA marketplace.

Catch up quick: ACA healthcare tax credits provide financial assistance to most marketplace enrollees and are set to expire at year’s end. Failing to extend these credits will drive premiums higher for millions. In fact, the average subsidized household’s premiums would more than double from $888 this year to $1,904 in 2026, per a prior KFF analysis. The issue remains a major sticking point in Congress, with Democrats and Republicans still far from a deal, media reports say. A vote to extend the credits is expected in the coming days, but pundits doubt it will pass.

Why it matters: Over half of ACA marketplace enrollees said they already struggle to afford out-of-pocket healthcare costs, including copays, deductibles, and the cost of premiums.

ACA enrollees think their financial hardships will get significantly worse if their tax credits expire.

• 78% said they couldn’t afford any increase over $1,000 per month without it disrupting their financial situation.
• A $300-per-month spike would be too much for 58% of people.
• 67% noted they’d be at least somewhat likely to cut back spending on food, clothing, or basic household items if their overall healthcare expenses increased by $1,000 per month.
• 41% said they might have to skip or delay paying other bills in this scenario.

Meanwhile, ACA enrollees say they would struggle to find alternative coverage that meets their needs if premiums surge.

• 89% said it would be difficult to find affordable coverage if their premiums rose too high.
• 52% said they might have to go without health insurance if their premium amount doubled.
• 44% said they might need to find a different job with suitable health coverage if their monthly insurance costs doubled.
• Just 10% said they’d be very likely to stick with their current plan and pay the much higher premium.

Implications for the healthcare system: The next few weeks will determine how many Americans lose coverage or face much higher insurance costs, with a congressional vote pending and a possible deal in play, plus the December 15 deadline for ACA members to pick a plan with coverage starting January 1.

Millions could either face higher insurance costs or lose it altogether—both scenarios have far-reaching effects on the economy and healthcare system. For workers of small businesses and the self-employed, careers could be upended in the search for reliable health coverage. Meanwhile, unaffordable insurance—or no coverage at all—will force people into difficult choices, such as delaying care and treatment or cutting other essentials to pay for healthcare. With coverage gaps possible as soon as next month, insurers will need to help members navigate changing eligibility and costs to avoid losing them.