(NEW YORK) — One in four Americans covered by the Affordable Care Act (ACA) are considering going without health insurance if their monthly premiums double next year, a new KFF poll published Thursday finds.

Open enrollment for the ACA began last month, and many Americans experienced sticker shock upon receiving their annual notices and discovering their 2026 premiums would be increasing.

At the same time, enhanced premium tax credits under the ACA, which help lower the cost of monthly premiums for about 22 million Americans, are set to expire at the end of the year, and it’s unclear if Congress will take action to extend them.

The survey, which included a nationally representative sample of 1,350 U.S. adults between ages 18 and 64 and was conducted during early to mid-November, found that many Americans are reconsidering coverage on the ACA marketplaces.

“What we’re really interested in is understanding how marketplace enrollees are thinking about their decisions around coverage in 2026 … and so we wanted to actually hear from the people that were being directly impacted by this,” Ashley Kirzinger, director of survey methodology at KFF, told ABC News.

The survey found that one in three people covered under the ACA said they would “very likely” shop for a cheaper plan if their premium payments doubled, or if they currently don’t pay a premium and would have to pay $50 a month.

Kirzinger said the finding that one in four Americans would “very likely” forego insurance if faced with the same scenario is concerning.

“One of the things that the Affordable Care Act did was decrease our uninsurance rate in this country,” she said. “And so this could have major implications and major consequences as more people become uninsured for the first time in a decade.”

“And so, it’s not that they want to go without coverage. It’s that that may be the only option available to them,” Kirzinger added.

‘We have to judge the value of our health’

One of the survey respondents, Jon, 38, from Florida, who withheld his last name due to privacy reasons, said his family needs a health insurance plan on the marketplace that has good coverage because his wife has an autoimmune disorder.

The monthly premium — which covers Jon, his wife and their two children — is currently $2,000 per month and is going up to $2,500 per month next year.

“Having health insurance is important,” he told ABC News. “We’re one accident from not being financially okay, one accident away from not being able to cover the cost of food, daily expenses.”

Jon said that his family is considering a plan next year that would lower the cost of the monthly premium but would raise their copay for doctor’s visits and emergency room visits

“Now we have to judge what the value of our health and nobody should have to judge the value of that,” he said.

The survey also found that 58% of enrollees, or six in 10 Americans, say they could not afford an annual increase of just $300 per year without significantly disrupting their household finances.

An additional 20% said they would not be able to afford a $1,000 per year increase without disrupting their finances.

If total health care costs — including premiums, deductibles and other expenses increase by $1,000 next year, about 67% of marketplace enrollees said they would likely cut down on daily household needs and 41% said they would likely skip or delay other bills, according to the survey.

‘Our most difficult monthly cost’

More than half of ACA policyholders, or 54%, said they expect the cost of their health insurance coverage next year to “increase a lot more than usual,” with one in four saying it will “increase a little more than usual,” the survey found.

Another survey respondent, Venus, 27, from Kentucky, who withheld her last name due to privacy reasons, told ABC News it’s currently difficult to pay for the cost of her and her husband’s monthly health insurance premiums.

“Mainly because we only have one income and we have to pay for two health insurances for people with two different chronic illnesses,” she said. “It’s our most difficult monthly cost to pay.”

Venus explained that because they need an insurance plan with a higher deductible, their premium is lower, but out-of-pocket costs are higher.

She and her husband pay about $200 each month, and their monthly premium is expected to increase $90, which will eat into their monthly budget.

If premiums doubled, she said she and her husband would have to consider going without insurance.

“I don’t even have the words for that,” she said, “Paying for insulin out-of-pocket, I just couldn’t imagine.”

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