Challenges of Rising ACA Premiums and the Impact on American Families

On February 2, 2026, CBS News covered a significant issue affecting many Americans: the expiration of enhanced Affordable Care Act (ACA) subsidies. These subsidies had provided vital assistance to numerous individuals since 2021, but with their expiration, people like Noah Hulsman, Loretta Forbes, and Nicole Wipp are facing difficult financial decisions regarding their health care coverage.

Noah Hulsman, aged 37, owns a skate shop in Louisville, Kentucky. When he discovered he no longer qualified for federal subsidies to assist with his ACA “gold” plan, he switched to a less comprehensive coverage plan. However, the deductible now constitutes about a quarter of his annual income. Similarly, Loretta Forbes, a 56-year-old from near Nashville, Tennessee, had to abandon her plan when her ACA marketplace premiums skyrocketed tenfold in 2026. She started rationing her rheumatoid arthritis medications, and her husband, Jim, gave up his small handyman business to secure a job that offered insurance coverage.

In Aiken, South Carolina, Nicole Wipp and her husband made the tough decision to drop their family’s ACA plan due to prohibitively high premiums that surpassed their mortgage payment. They opted to cover only their 15-year-old son, citing their willingness to take a financial gamble.

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

The termination of the enhanced ACA subsidies has particularly impacted middle-income families, many of whom do not qualify for Medicaid. With rising costs in groceries, housing, and other essentials, the financial burden is heightened by increased healthcare expenses. A KFF poll revealed that more than 80% of Americans experienced an uptick in the cost of living last year, with health care costs emerging as their top concern. Approximately two-thirds of respondents expressed significant worry about affording healthcare.

Cheryl Fish-Parcham, director of private coverage at Families USA, emphasized the critical timing for Congress to take action, saying “Premiums are getting quite unaffordable for a lot of people. The cost of both health care and other basic needs is rising.”

Nonetheless, the GOP-led Congress has not opted to renew the enhanced subsidies. Instead, they are advocating for expanded health savings accounts and more plans with lower premiums and higher deductibles. President Donald Trump’s health plan suggests little in terms of reducing out-of-pocket costs. The One Big Beautiful Bill Act, which he signed, is expected to result in fewer insured individuals over the next decade by cutting federal health spending, primarily from Medicaid.

Federal data indicates that around 1.2 million fewer individuals have registered for ACA plans in 2026, largely attributed to the expectation that healthier people will exit the plans as tax credits decrease, leaving insurers with more high-cost patients. Consequently, ACA insurers have increased premiums by an average of 4 percentage points in 2026.

“Rising costs and lack of congressional action are forcing many to make ‘untenable choices,'” remarked Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University. She asserted that “people are faced with absorbing this huge financial and health risk.”

Loretta Forbes, who faced a substantial premium increase from $250 to $2,500, experienced the struggles many face. Her husband Jim gave up his handyman business, seeking employment with health benefits. Fortunately, just before their ACA plan lapsed, Jim obtained a job offering health coverage, and Loretta was approved for Medicare due to her disability.

Even those maintaining insurance face higher expenses. This year, ACA marketplace insurance premiums rose by an average of 26%, driven by factors like increased hospital costs and the popularity of expensive GLP-1 drugs for obesity and diabetes.

Noah Hulsman, with a modest income from his skate shop, opted for a “bronze” plan with a deductible of $8,450, up from $750 the previous year. Living in Kentucky, where consumer protections for medical debt are limited, Hulsman decided against dropping his insurance.

“I’m just riding the line right now,” he said, expressing concerns about potential major accidents that could financially strain his business.

In South Carolina, Nicole Wipp and her family squeezed in routine vaccinations on New Year’s Eve, the last day of their plan’s coverage. Their new ACA options would cost significantly more, and they opted to cover only their son, due to the unaffordable premiums and deductibles.

With limited options for financial relief, Wipp highlighted that their situation leaves them to rely on an old health savings account and, if necessary, filing for bankruptcy.

The challenges facing these families underscore the pressing need for affordable health insurance solutions. Personal health stories like these can shape the future of healthcare policy, highlighting the human impact of financial decisions in health care.