When Noah Hulsman, who owns a skate shop in Louisville, Kentucky, learned he no longer qualified for federal subsidies to help him pay for his \u201cgold\u201d Affordable Care Act health plan, the 37-year-old opted for skimpier coverage. But the deductible is about a quarter of his yearly income.<\/p>\n
Loretta Forbes realized she would have to drop her plan after her monthly ACA marketplace premiums jumped tenfold in 2026. So the 56-year-old, who lives outside Nashville, Tennessee, started rationing her rheumatoid arthritis medications. Her husband, Jim, gave up on his fledgling handyman business and started looking for a job with insurance coverage.<\/p>\n
And when Nicole Wipp learned the monthly premium for her family\u2019s ACA plan would be more than their mortgage payment, she and her husband decided to drop their family plan and buy coverage only for their 15-year-old son.<\/p>\n
After crunching the numbers, Wipp, 54, a self-employed lawyer in Aiken, South Carolina, said she and her family made the tough call.<\/p>\n
\u201cWe decided that, ultimately, it would be better for us to gamble.\u201d<\/p>\n
Despite a contentious back-and-forth and the longest government shutdown in history last fall, the GOP-led Congress allowed enhanced ACA subsidies, which had helped millions of Americans cover all or part of their marketplace premiums since 2021, to expire on Dec. 31. With the loss of the subsidies and health care costs already surging, more middle-income people<\/a> face tough decisions about their health coverage this year.<\/p>\n Hulsman, Forbes, and Wipp don\u2019t qualify for Medicaid, the public insurance program for those with low incomes or disabilities. But like many others, they are being squeezed by the increasing costs of groceries, housing, and other necessities. Rising monthly health insurance premiums, along with copayments, high deductibles, and other out-of-pocket medical costs, can often push families like these to the brink.<\/p>\n More than 80% of Americans said their cost of living has increased in the past year, according to a January poll<\/a> from KFF, a health information nonprofit<\/a> that includes KFF Health News. Health care costs ranked at the top of their concerns, with about two-thirds saying that they are somewhat or very worried about affording health care \u2014 more than said the same about other necessities, such as food and housing, the poll found.<\/a><\/a><\/p>\n \u201cPremiums are getting quite unaffordable for a lot of people. The cost of both health care and other basic needs is rising,\u201d said Cheryl Fish-Parcham<\/a>, director of private coverage at the health consumer group Families USA. \u201cThis is an especially critical time for Congress to do something.\u201d<\/p>\n Most Republican lawmakers have refused to renew the enhanced subsidies. Most of the public says that inaction by Congress was the \u201cwrong thing,\u201d according to the KFF poll. Instead, GOP lawmakers have advocated for an expansion of health savings accounts<\/a> and for more plans with lower premiums and steeper deductibles and copays that don\u2019t reduce overall costs.<\/p>\n President Donald Trump released an outline of a health plan<\/a> in January with few details about how to lower out-of-pocket costs for millions of Americans. The One Big Beautiful Bill Act, which he signed in July, is expected to leave millions uninsured over the next decade as it reduces federal health spending by nearly $1 trillion, mostly from Medicaid.<\/p>\n Already about 1.2 million fewer people have signed up for plans for this year under the ACA, also known as Obamacare, according to federal data<\/a>. Health policy analysts expect more people to stop making payments and drop coverage in the coming months. ACA marketplace insurers have said that they are charging 4 percentage points more in 2026 because they expect healthier people to drop plans as enhanced tax credits expire, leaving more sick and high-cost patients.<\/p>\n Rising costs and lack of congressional action are forcing many to make \u201cuntenable choices,\u201d said Joan Alker<\/a>, executive director and co-founder of the Center for Children and Families at Georgetown University.<\/p>\n \u201cPeople are faced with absorbing this huge financial and health risk,\u201d she said.<\/p>\n Forbes, the woman with rheumatoid arthritis near Nashville, had been on an ACA marketplace plan since 2018. But this year she and her husband, Jim, dropped their coverage after learning the monthly premium would jump from $250 to $2,500 because the enhanced subsidies expired. Jim, 59, gave up his handyman business and began searching for a job with health insurance.<\/p>\n \u201cWe were like: \u2018OK, we can\u2019t breathe. We\u2019re gonna tap out,\u2019\u201d said Forbes, who was diagnosed with cervical cancer in 2021. Last year she lost her job at a retirement facility because she couldn\u2019t work after she had a hysterectomy.<\/p>\n A day before their ACA coverage lapsed, her husband got a job offer at a property management company that provides health coverage. In January, they learned that Forbes was approved for Medicare because of her disability. The $155 monthly premium is automatically deducted from her disability check, she said.<\/p>\n Forbes\u2019 Medicare plan starts in February, just in time for her next cancer screening.<\/p>\n \u201cYou cannot imagine what a relief it is to know I will have care,\u201d Forbes said.<\/p>\n Even those who are insured face drastically higher out-of-pocket costs. This year, health insurers\u2019 premiums for ACA marketplace plans jumped an average of 26%<\/a>, the result of higher hospital costs, the popularity of pricey GLP-1 drugs for obesity and diabetes, and the threat of tariffs, according to KFF. Nearly 4 in 10 adults said they were skipping or postponing necessary care because of costs, a 2025 KFF poll<\/a> showed.<\/p>\n Hulsman, the Louisville shop owner, said he takes home about $33,000 a year from his business. Last year he paid about $105 a month for a gold plan on the marketplace, with a $750 deductible. This year, with the loss of the enhanced subsidy, Hulsman is paying the same monthly premium for a \u201cbronze\u201d plan, but with a deductible of $8,450, which he must pay out-of-pocket before his insurer starts paying for care. On average, deductibles for bronze plans are more than four times those of gold plans, according to a KFF analysis of 2026 marketplace plans<\/a>.<\/p>\n Hulsman didn\u2019t consider dropping health insurance, because Kentucky has limited consumer protections for medical debt<\/a>. But he said he\u2019ll try to get an estimate if he needs to go to a doctor. And he\u2019s worried that a major accident could wipe out his skate shop. He won\u2019t be able to buy inventory or pay shop bills if he has to meet his full deductible, he said.<\/p>\n \u201cI\u2019m just riding the line right now,\u201d the skateboarder said. \u201cOne slip and it\u2019s gonna be uncomfortable.\u201d<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n In South Carolina, Wipp dragged her family to get routine vaccinations on New Year\u2019s Eve \u2014 the last day that she and her husband had health coverage.<\/p>\n This year\u2019s monthly premium for a bare-bones bronze family plan would have cost them $1,400, up from $900 last year. They would still have faced high copays for doctor visits and need to meet a deductible of more than $10,000. Instead, they\u2019re paying around $200 to cover just her son.<\/p>\n Wipp, who has a rare condition that causes cysts and other growths to form in the lungs, said she and her husband plan to pay out-of-pocket this year for any initial preventive care. Their second source of money, for larger medical expenses, is an old health savings account. But she said that account doesn\u2019t have enough to cover a major accident or illness. And Wipp can\u2019t add to the account while she is uninsured.<\/p>\n \u201cThe third source would be, I don\u2019t know,\u201d Wipp said. \u201cThe fourth is bankruptcy.\u201d<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here<\/a>\u202fto contact KFF Health News and share your story.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n