Black Book Survey: ACA Enrollees Fear Coverage Crisis Amid Economic Uncertainty
TL/DR –
A national survey by Black Book Research indicates widespread opposition among Affordable Care Act (ACA) enrollees towards proposed healthcare policy changes. The survey, conducted between March 5 and April 20, 2025, polled 1,000 ACA participants from 28 states, highlighting their concerns about potential coverage loss, financial stress, and opposition to proposed ACA changes. As of 2025, approximately 24.2 million Americans rely on ACA Marketplace plans, a peak driven by enhanced subsidies introduced by the American Rescue Plan Act (2021) and extended through 2025 by the Inflation Reduction Act.
Black Book Research Survey Uncovers Widespread Concerns Regarding Proposed ACA Changes
Black Book Research’s recent national survey unveils significant opposition among Affordable Care Act (ACA) enrollees towards proposed healthcare policy alterations by the current administration. The survey, carried out between March 5 and April 20, 2025, collated insights from 1,000 ACA participants across 28 states. These states currently utilize the Federally Facilitated Marketplace, thereby accessing health insurance plans through HealthCare.gov.
Currently, an estimated 24.2 million Americans depend on ACA Marketplace plans, reaching an unprecedented enrollment peak. This spike is largely influenced by extended subsidies from the American Rescue Plan Act (2021) and the Inflation Reduction Act. Overall, over 45 million Americans rely on ACA-related coverage, encompassing Medicaid expansion.
States with remarkable ACA enrollment growth since 2020 include Texas (255% surge), Mississippi (242% rise), West Virginia and Louisiana (234% increase each), Georgia (227% growth), and Tennessee (221% increase).
Understanding ACA Changes: Communication and Awareness Gaps
Only 18% of respondents were aware of the proposed ACA changes, indicating critical communication shortfalls. The administration has proposed numerous changes to ACA that could drastically impact how Americans access health insurance. Key changes include shortening the annual open enrollment period, ending the monthly enrollment option for low-income individuals, and tightening enrollment eligibility oversight.
Concerns About Losing ACA Coverage
An overwhelming 93% expressed serious concerns about potentially losing ACA coverage. The proposed changes to the ACA could result in an estimated 750,000 to 2 million people losing their health coverage, with coverage losses being most concentrated in states like Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and Utah.
Financial Stress and Potential Coverage Loss
90% of respondents indicated that premium increases would severely affect their finances, with 59% reporting they would likely discontinue their health insurance if premiums significantly increased. A significant 67% of respondents cited increased unemployment fears, specifically recent layoffs of federal workers as a notable concern.
Strong Opposition to ACA Changes
Only 9% supported the proposed ACA modifications, while 78% opposed the changes. Even among Republican voters, there is significant support for maintaining or increasing Medicaid funding.
Preferred Solutions of Respondents
68% favored expanding subsidies for ACA affordability, 33% supported introducing a public healthcare option, and 20% suggested strengthening Medicaid expansion for low-income individuals.
Survey Methodology
The survey incorporated rigorous methodology, utilizing stratified sampling to reflect diverse demographics. Data was collected via email and online platforms via a third-party panel supported sample.
About Black Book Research
Black Book Research is an independent market research firm specializing in healthcare, technology and public opinion. For more information, contact Black Book Research.
Source: Black Book Research
—
Read More US Economic News