Families Struggle as Health Insurance Costs Soar

Loss of ACA subsidies forces tough choices between coverage and other necessities

Published on Feb. 3, 2026

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When federal subsidies for Affordable Care Act health plans expired at the end of 2025, many middle-income Americans found themselves facing skyrocketing monthly premiums that exceeded their mortgage payments. Faced with the choice of paying for health coverage or other basic needs, some families have opted to drop or downgrade their plans, leaving them vulnerable to high out-of-pocket costs or even bankruptcy in the event of a major medical emergency.

Why it matters

The loss of enhanced ACA subsidies has exacerbated the ongoing affordability crisis in healthcare, forcing many Americans to make difficult tradeoffs between health coverage and other essential expenses like housing, food, and transportation. This issue disproportionately impacts the self-employed, small business owners, and others without access to employer-sponsored insurance, highlighting the need for policy solutions to ensure access to affordable, comprehensive health plans.

The details

After the GOP-led Congress allowed the enhanced ACA subsidies to expire, individuals like Noah Hulsman, Loretta Forbes, and Nicole Wipp have been forced to either pay dramatically higher premiums, downgrade their coverage, or drop their plans altogether. Hulsman, who owns a skate shop in Louisville, Kentucky, is now paying the same monthly premium for a bronze plan with an $8,450 deductible as he previously paid for a gold plan with a $750 deductible. Forbes and her husband near Nashville, Tennessee, had to drop their ACA coverage when the monthly premium jumped from $250 to $2,500, until her husband found a job with employer-sponsored insurance. Wipp, a self-employed lawyer in South Carolina, decided to drop coverage for herself and her husband and only insure their 15-year-old son, as the family plan would have cost more than their mortgage.

  • In January 2026, the enhanced ACA subsidies expired.
  • In 2025, health insurers' premiums for ACA marketplace plans jumped an average of 26%.
  • In 2021, the enhanced ACA subsidies were first introduced to help millions of Americans cover all or part of their marketplace premiums.

The players

Noah Hulsman

A 37-year-old who owns a skate shop in Louisville, Kentucky.

Loretta Forbes

A 56-year-old woman living outside Nashville, Tennessee who has rheumatoid arthritis and was previously diagnosed with cervical cancer.

Nicole Wipp

A 54-year-old self-employed lawyer in Aiken, South Carolina who has a rare condition that causes cysts and other growths to form in her lungs.

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What they’re saying

“We decided that, ultimately, it would be better for us to gamble.”

— Nicole Wipp (northdenvernews.com)

“You cannot imagine what a relief it is to know I will have care.”

— Loretta Forbes (northdenvernews.com)

“I'm just riding the line right now. One slip and it's gonna be uncomfortable.”

— Noah Hulsman (northdenvernews.com)

What’s next

Congress is facing growing public pressure to renew the enhanced ACA subsidies, with most Americans saying that inaction by lawmakers was the 'wrong thing'. However, Republican lawmakers have so far resisted calls to restore the subsidies, instead advocating for an expansion of health savings accounts and more plans with lower premiums but higher deductibles and copays.

The takeaway

The expiration of the ACA's enhanced subsidies has exacerbated the ongoing healthcare affordability crisis, forcing many middle-income Americans to make untenable choices between paying for health coverage or other basic necessities. This issue highlights the urgent need for Congress to take action to ensure access to comprehensive, affordable health plans, especially for the self-employed, small business owners, and others without employer-sponsored insurance.