Main roads
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The rising cost of health insurance under the Affordable Care Act is forcing millions of families to drop coverage
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New research shows that the cheapest plans without subsidies are becoming unaffordable for ordinary people
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As healthier people drop coverage, fewer people are subsidized, which causes premiums to rise again.
MONDAY, June 22, 2026 (NewsDay News) – Ross and Rebecca Tobiassen have seen their health care costs rise year after year after relying on the Affordable Care Act for federally subsidized health insurance since it began in 2014. Year after year, the couple in western North Carolina kept the value of peace.
But in December, the situation changed. The Tobiassens decided to cancel their insurance when Rebecca saw the cost of their monthly premiums increase from $130 to $550.
“It makes no sense,” he said. “It’s not worth it anymore.”
The couple owns a small auto shop just west of Appalachian State University in the mountains of North Carolina. Rebecca is worried about her husband, whose mechanical work can be dangerous. Once a spring shot a metal ball into the wall of their garage like a gun. Something heavy pressed against Ross’s finger. In 2020, Ross was left largely blind in one eye after falling into metal shards and developing an infection in his eye.
The Tobiassens are among Americans who will drop their ACA coverage after Congress approved enhanced tax credits that will allow them to pay for insurance plans through the end of 2025. The Tobiassens benefited from these tax credits.millions of other entrantsThey are expected to drop out of coverage as the year goes on or be unable to meet the higher costs.
Created by the Biden administration’s America’s Rescue Plan Act during the COVID pandemic, expanded subsidies have reduced monthly premiums for many families and sparked a wave of new enrollments, doubling ACA enrollment.about 24 million.
The Centers for Medicare & Medicaid Services is expected topost full info soonabout how many people are no longer covered under the ACA, but oneearly analysis from KFFciting a study by Wakely Consulting Group, showed that enrollment could drop from 22 million at the end of 2025 to 16.5 million in 2026.
In North Carolina, individual ACA enrollment for 2026 fell 22% from the previous year, the largest drop of more than 213,000 in any other state.according to registration information. While the Tobiassens’ two teenage daughters remain on Medicaid, Rebecca said the new rates show the federal government doesn’t care about families like hers.
“We knew you didn’t care about us,” he said, “but you’re making it plain and simple now.”
The couple’s insurance did not help them cover all of their medical needs. When the pain worsened from Ross’s eye infection five years ago, Rebecca insisted on seeing a specialist and told them she was going to fix the eye with a corneal replacement surgery.it will cost them up to $30,000and requires Ross to take six months off.
Ross opted for a less expensive treatment that kills the optic nerve instead.
The couple knows they are at risk without insurance. If something were to happen, they could face huge medical bills.
Ross, 47, said being blind in one eye doesn’t affect his work much. He works long hours, sometimes late into the night, to meet demand.
“I try not to think about it too much,” he said. “I’m just working.”
Kathy Alexander oversees volunteers at Pisgah Legal Services, a western North Carolina nonprofit that helps low-income people secure health insurance. Alexander has helped residents in North Carolina and Tennessee get ACA marketplace plans since Obamacare was enacted. He said he had never seen anything like it this year.
About 100 Pisgah customers, out of about 700 that Alexander’s team worked with during open enrollment, decided to drop insurance this year, many choosing cheaper ACA plans with less coverage, Alexander said.
People who have dropped their coverage include Lyft and Uber drivers, he said. They are trying to start their own business. They are artists and people who can only work part-time because they have a chronic illness. Some can’t get insurance through their employer, or they work too much to qualify for Medicaid.
“Even for people who don’t have a chronic illness,” Alexander said, “there’s just this sadness in the back of your mind that’s always about, ‘Don’t be sad, don’t be sick. Because you can’t do that.”
ACA premiums and deductibles have increased steadily in the years since 2022, and then increased during the enrollment period for 2026 plans.according to the information analyzed by KFF. The Tobiassens have seen every drop and rise in plan costs since 2014, when the plans began. They joined right away and paid about $30 a month, Rebecca Tobiassen said.
“You really felt like you were benefiting,” she said.
But over the years, as the market became more expensive, the couple relented and at one point switched from the silver plan — historicallythe most common– to brass. The plan provided most of the basic needs of the husband and wife.
As they watched their deductibles and premiums rise for more than a decade, Rebecca feared the day would come when they wouldn’t even have the cheapest plan.
“Plans are elusive no matter how you slice it,” he saidRisha Gidwanihealth policy researcher at the University of Colorado Anschutz School of Medicine. “It’s just a matter of who carries the untouchable.”
Gidwani and the health economistSheryl Dambergin aThe study was published earlier this yearfound that most bronze plans, the cheapest ACA options for many, would be unaffordable for the average person who uses federal health coverage without subsidies.
Gidwani’s research shows that without the subsidy, many families using these plans would not have enough to pay premiums or deductibles.
People who drop health insurance also change what’s known as a “risk pool,” Gidwani said, when a group of people share financial risks.
If healthier people leave the risk pool, fewer people will help sick people, Gidwani said. This means that premiums for sick people will increase again in the future, he added.
“This is what we call a death spiral,” Gidwani said.
Even if the subsidies hadn’t ended, taxpayers would have estimated350 billion dollarsduring the next decade to cover them, Gidwani’s research noted.
After ending the coverage they relied on for 11 years, the Tobiassens have no plans to return to the ACA marketplace. They discussed alternative options through a faith-based health care organization, but decided to go without.
At the moment, they don’t have a plan B. They have set aside some money for emergency medical care. And if their savings run out, Rebecca Tobiassen said, they have one last resort to rely on: credit cards or family members.
Are you struggling to pay your health insurance? Have you decided to opt out of coverage?Click hereTo contact KFF Health News and share your story.
More information
AARP has a guide on what to do if you can’t health insurance.
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KFF Health News is a national news center that produces in-depth journalism on health issues and is one of the main operating programs of KFF – an independent source of health policy research, polling and journalism.
What does this mean for you?
Health insurance costs continue to rise under the Affordable Care Act.
