BOISE, Idaho \u2014 Joshua and Ashley Durham run a family medicine practice, and for the first time in their lives, they have no health insurance. <\/p>\n
When the Durhams began their practice at the end of 2023 \u2014 he as a primary care physician and she as a pharmacist who handles the billing \u2014 the couple bought coverage for themselves and their two kids on the Affordable Care Act marketplace. But they said their monthly premiums for a similar health plan for this year rose several hundred dollars to nearly $1,600.<\/p>\n
They decided to pay out-of-pocket for their medical expenses instead, leaning on $50,000 they had set aside in a health savings account over several years.<\/p>\n
\u201cIt\u2019s nerve-racking,\u201d said Joshua Durham, 47. \u201cIt just takes, you know, one little accident, and then you got a big fat bill.\u201d<\/p>\n
The healthcare industry traditionally has more of its workforce on medical insurance than many other fields. Nationwide, 7% of all healthcare workers were uninsured in 2024, compared with 11% of all adults under 65, according to a KFF analysis of the most recent American Community Survey data. And doctors were especially unlikely to forgo health insurance, with just 2% uninsured.<\/p>\n
But even healthcare workers are feeling the pinch as health insurance costs rise<\/a> each year, with employers expecting that costs will jump an additional 8.2%<\/a> for 2027.<\/p>\n The Republican-led Congress also opted last year not to renew<\/a> Affordable Care Act marketplace credits enacted during the covid pandemic. While subsidies remain in place for people with low incomes, the pandemic-era credits helped reduce many consumers\u2019 premium payments<\/a>, especially those working in small businesses such as independent medical practices. Nearly half of marketplace enrollees worked for small businesses or were self-employed<\/a> in 2024; some of the most common occupations included chiropractic care and dentistry.<\/p>\n Jack Dillon, executive director of the Association for Independent Medicine<\/a>, which represents 4,000 physician-led practices, said premium increases have become untenable for small businesses, whether employers seek coverage through the marketplace or directly from insurers.<\/p>\n \u201cThe cost has become so astronomical,\u201d Dillon said. \u201cYou\u2019re looking at it and saying, \u2018What\u2019s the value?\u2019\u201d<\/p>\n As health insurance continues to become less affordable, Dillon said, more healthcare employers may seek alternatives to their standard coverage, such as providing higher hourly wages or providing only minimal plans.<\/p>\n The number of people without insurance in the U.S. is expected to increase by roughly 15 million<\/a> over 10 years because of the expiration of the expanded ACA subsidies and $1.1 trillion in estimated cuts<\/a> resulting from President Donald Trump\u2019s signature One Big Beautiful Bill Act, according to the Congressional Budget Office.<\/a><\/p>\n Healthier people are the most likely to opt out of insurance. That leaves insurance covering a smaller pool of people who tend to be sicker and need more expensive care. So insurers raise prices to cover the remaining enrollees, which fuels even higher premium costs.<\/p>\n \u2018Healthcare Is a Business\u2019<\/strong><\/p>\n Samantha LeGault, a nurse practitioner at a health clinic in Boise, said her employer-offered plan\u2019s premium payment rose from $700 to $1,500 a month this year to insure herself, her husband, and four of their kids. LeGault has Crohn\u2019s disease and two of their daughters also have medical conditions, so she said her family has no choice but to continue to pay for that health coverage.<\/p>\n But she decided to skip dental insurance to save money, and she prioritizes dental visits for her children over herself.<\/p>\n She had already struggled to set aside retirement savings and had switched her children from a private school they liked to public school to cut down on costs. Then the new health insurance costs tightened her budget even more. She estimated that about one-fifth of her income now goes toward her monthly premium payments.<\/p>\n \u201cI know how the clinics work, that I am an expensive patient,\u201d LeGault said. \u201cAt the end of the day, healthcare is a business in the United States.\u201d<\/p>\n Samantha LeGault, a nurse practitioner for a health clinic in Boise, says her medical insurance premium costs rose from $700 to $1,500 a month this year to cover her, her husband, and four of their kids. She has Crohn\u2019s disease, and two of her daughters also have medical conditions. She continues to pay for health coverage but opted to skip dental insurance to reduce their monthly expenses. (Hayat Norimine\/KFF Health News)<\/p>\n The Durhams have three other employees in their practice. Two of them receive health insurance through their spouses, Ashley Durham said. The Durhams said they pay $420 monthly toward their physician assistant\u2019s premiums.<\/p>\n As a primary care physician, Joshua Durham said he doesn\u2019t need regular doctor visits, because he can diagnose and treat himself \u2014 and, if needed, the rest of his family, though he acknowledged that\u2019s frowned upon. The American Medical Association\u2019s code of ethics<\/a> generally discourages doctors from treating themselves or relatives but makes exceptions for emergency situations or short-term, minor problems. Ashley Durham said she\u2019s filled prescriptions for her family.<\/p>\n Arthur Caplan<\/a>, a bioethicist and professor emeritus at New York University\u2019s Grossman School of Medicine, said that as more people are \u201cturning toward relatives because they can\u2019t access or easily see a regular doctor,\u201d it may make sense to revisit that aspect of the code of ethics.<\/p>\n Out-of-Pocket Expenses<\/strong><\/p>\n Healthcare workers with less advanced medical certifications than the Durhams often don\u2019t have the option of treating themselves or family members \u2014 or don\u2019t have savings to fall back on for healthcare expenses. And many healthcare professionals, such as Jill Kordick, a 64-year-old retired healthcare executive in Norwalk, Iowa, aren\u2019t willing to go without the safety net of insurance.<\/p>\n In her work, Kordick saw hospitalizations become financially devastating for patients, so she said she would never opt out of health insurance \u2014 even for just the 16 months before she\u2019d become eligible for Medicare at age 65.<\/p>\n Last year, she qualified for the enhanced Affordable Care Act tax credits, allowing her to pay $75 a month for health coverage. Her premiums rose to $800 a month this year when those subsidies expired.<\/p>\n Because she has a $10,000 deductible, she put off going to the doctor for weeks when she had a sinus infection this year, until it ultimately evolved into an ear infection. She said she regularly rethinks, and sometimes returns, nonessential groceries in her shopping cart. And she keeps her house\u2019s thermostat at 80 degrees in the summer to cut down on air conditioning costs.<\/p>\n Kordick said healthcare is a universal struggle in this country, regardless of how familiar patients are with the industry. \u201cIt\u2019s disheartening that it\u2019s as broken and fragmented as it is,\u201d she said.<\/p>\n The Durhams have seen the impact of unaffordable healthcare on their patients. They said they try to lend some leeway to patients when they can \u2014 a luxury they have, operating their own practice. In one case, Ashley Durham said, she wrote off $1,160 in bills for a single father whose son didn\u2019t have health insurance rather than send their bills to a collection agency.<\/p>\n \u201cIt\u2019s hard, because as a human I want to help them out,\u201d she said. \u201cAt the same time, we need revenue for our office.\u201d<\/p>\n Joshua Durham is more nervous about going uninsured than his wife. As a child, he witnessed his parents struggling to pay medical bills for their family of nine in south-central Idaho. Durham recalled that his dad, who was a carpenter, helped build a surgeon\u2019s house to pay for an operation.<\/p>\n Today, Durham also sometimes exchanges work for care. He said he gets free eye exams from an uninsured optometrist and offers him free primary care.<\/p>\n He worries about a worst-case scenario: a car crash, a sports injury, a serious diagnosis.<\/p>\n \u201cDo I have pancreatic cancer today?\u201d Durham said wryly.<\/p>\n So far, the couple has paid around $9,000 total for expenses out of their health savings account this year, including physical therapy to help with the thoracic outlet syndrome that affects Durham\u2019s neck and shoulder, mental health appointments, and contact lenses. The expenses were higher than the Durhams anticipated. But it was still less than what their monthly premiums would have cost them.<\/p>\n Their decision has paid off, Joshua Durham said. At least for now.<\/p>\n The Durhams used the Affordable Care Act marketplace for health insurance for their family of four last year. This year, they chose to pay out-of-pocket for care instead when the cost of their premium payments jumped. (Hayat Norimine\/KFF Health News)<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage?\u00a0<\/em>Click here<\/em><\/a>\u00a0to 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>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" BOISE, Idaho \u2014 Joshua and Ashley Durham run a family medicine practice, and for the first time in their lives, they have no health insurance. 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