The Impact of Rising Health Insurance Premiums on American Families

The expiration of enhanced federal subsidies for Affordable Care Act (ACA) plans at the end of 2025 has prompted challenging decisions for many American families in 2026. Noah Hulsman, a 37-year-old skate shop owner from Louisville, Kentucky, faced a difficult choice when he learned he was no longer eligible for subsidies to support his ‘gold’ ACA health plan. Ultimately, he opted for a plan with a higher deductible, which represents about a quarter of his annual income.

Loretta Forbes, who resides near Nashville, Tennessee, experienced a tenfold increase in her monthly ACA marketplace premiums. As a result, she began rationing her medications for rheumatoid arthritis. Facing similar financial pressures, her husband Jim decided to seek employment with health insurance benefits, abandoning his budding handyman business.

Nicole Wipp and her husband Marcus Sutherland, residents of Aiken, South Carolina, found that the monthly premium for their family’s ACA plan exceeded their mortgage payment. This prompted them to make a tough decision: drop their family plan but maintain coverage for their 15-year-old son, Marek.

These individuals are among many who do not qualify for Medicaid yet are feeling the squeeze from rising expenses on necessities such as groceries and housing. Health insurance premiums, copayments, high deductibles, and other medical costs pushed them to the brink as inflation compounds the dilemma. According to a January KFF poll, over 80% of Americans indicated that their cost of living has risen in the past year, with healthcare costs being their top concern.

“Premiums are getting quite unaffordable for a lot of people. The cost of both healthcare and other basic needs is rising,” said Cheryl Fish-Parcham, director of private coverage at the health consumer group Families USA.

This scenario is compounded by a GOP-led Congress allowing enhanced ACA subsidies to expire, leaving millions to grapple with higher costs. Though many Americans see Congress’s inaction as the “wrong thing,” the debate continues. Republican lawmakers have emphasized expanding health savings accounts and lower-premium plans, while President Donald Trump’s health policy proposals have yet to address specific out-of-pocket cost reductions.

Amidst these challenges, insurance signups under ACA have already decreased by 1.2 million for this year, as healthy individuals drop plans due to expired tax credits. Consequently, insurers are increasing premiums by an average of 4 percentage points this year as risk pools become skewed towards high-cost patients, placing even more strain on those who can ill afford it.

Loretta Forbes’s story underscores the harsh realities many face. Having been on an ACA marketplace plan since 2018, she and her husband Jim saw their premium jump from $250 to $2,500 a month due to the subsidy loss. Jim halted his handyman business and eventually found employment with health benefits. Fortunately, Loretta qualifies for Medicare due to her disability beginning in February, offering some relief amid her medical challenges.

Health insurance plans offered via the ACA marketplaces experienced a 26% average rate increase this year, a result of factors such as rising hospital costs and the popularity of expensive medications for diabetes and obesity. A KFF survey in 2025 revealed that nearly 40% of adults postponed or skipped necessary care due to these climbing costs.

Noah Hulsman, who owns a skate shop, highlights the perils of high deductibles. Operating on approximately $33,000 annually, he faced a $750 deductible for his gold plan last year. This year, with diminished subsidies, his bronze plan not only costs the same premium, but imposes an $8,450 deductible. In Kentucky, where consumer protections for medical debt are limited, Hulsman fears a major accident could threaten his small business.

Nicole Wipp, suffering from a rare lung condition, had to weigh their healthcare needs against the steep costs. Maintaining insurance for just their son, their family needs contemplate out-of-pocket care or tap into an old health savings account. However, funds are insufficient for covering substantial accidents or illness, raising concerns about potential financial insolvency.