Middle-income Families Face Tough Choices as ACA Costs Soar in 2026

Three families share stories of dropping coverage, switching to high-deductible plans, and insuring only their children as premiums become unaffordable.

Published on Feb. 5, 2026

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After the expiration of enhanced Affordable Care Act subsidies, middle-income families across the U.S. are facing difficult decisions about their health coverage. Three families from Kentucky, Tennessee, and South Carolina describe opting for skimpier plans with high deductibles, dropping coverage altogether, or insuring only their children as monthly premiums become unaffordable, often exceeding their mortgage payments.

Why it matters

The loss of ACA subsidies, combined with rising costs of other necessities like food and housing, is forcing many middle-income Americans to make tough trade-offs about their health care. This highlights the ongoing challenges of ensuring affordable access to health coverage, especially for those who don't qualify for Medicaid but still struggle to afford premiums and out-of-pocket costs.

The details

Noah Hulsman, a small business owner in Louisville, Kentucky, had to switch from a 'gold' ACA plan with a $750 deductible to a 'bronze' plan with an $8,450 deductible after losing his subsidies. Loretta Forbes and her husband in Tennessee dropped their ACA coverage entirely after their monthly premium jumped from $250 to $2,500, with Forbes rationing her rheumatoid arthritis medication. In South Carolina, Nicole Wipp and her husband decided to drop their family ACA plan and only insure their 15-year-old son, as the new $1,400 monthly premium was more than their mortgage.

  • In January 2026, the enhanced ACA subsidies that had helped millions of Americans cover their marketplace premiums since 2021 expired.
  • In 2025, about 1.2 million fewer people signed up for ACA plans compared to previous years, as healthier individuals dropped coverage.
  • In 2026, ACA marketplace insurers raised premiums by an average of 26% due to higher hospital costs, popular but expensive drugs, and the threat of tariffs.

The players

Noah Hulsman

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

Loretta Forbes

A 56-year-old woman living outside Nashville, Tennessee who had to drop her ACA coverage after her monthly premiums increased tenfold.

Nicole Wipp

A 54-year-old self-employed lawyer in Aiken, South Carolina who decided to drop her family's ACA plan and only insure her 15-year-old son.

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What they’re saying

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

— Nicole Wipp, Self-employed lawyer

“We were like: 'OK, we can't breathe. We're gonna tap out.'”

— Loretta Forbes

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

— Noah Hulsman, Small business owner

What’s next

The judge in the case will decide on Tuesday whether or not to allow Walker Reed Quinn out on bail.

The takeaway

This situation highlights the ongoing challenges of ensuring affordable access to health coverage, especially for middle-income Americans who don't qualify for Medicaid but still struggle to afford rising premiums and out-of-pocket costs. It raises questions about the role of Congress in renewing ACA subsidies and the need for more sustainable solutions to make health care more affordable for all.