Unless Congress acts in the next month, up to four million Americans are expected to become uninsured, because they can no longer afford their health insurance premiums.
While Congress has finally reached a deal to end the longest government shutdown on record, during which Democrats pressed Republicans to lower people’s health insurance costs, Democrats relented without a compromise that would avert the country’s imminent health care policy catastrophe. The two sides now need to agree on a deal to prevent the millions of Americans who purchase health insurance through the Affordable Care Act’s marketplaces from facing an average 30 percent premium hike next year.
Key takeaways from our interviews with the new uninsured
- Vox spoke with a group of people from a variety of backgrounds — a young gig worker, a father and husband, an early retiree, and a middle-aged entrepreneur — who are facing extremely difficult choices as their health care costs climb.
- They could be forced to take shortcuts on their health: skipping appointments, stockpiling medicines, and possibly going uninsured altogether.
- They feel the politicians who could fix this for them are more worried about scoring political points than fixing the US health system.
If lawmakers don’t act, health insurance premiums are poised to climb five or six times what some policyholders paid just last year.
More than 20 million people buy insurance on the marketplaces, and now, many are experiencing sticker shock as they realize their insurance options are much more expensive or that they have lost all of their assistance and are completely priced out of medical coverage.
Democrats have forced Republicans to agree to a vote on restoring people’s health insurance subsidies by mid-December as a condition of ending the shutdown. Bipartisan negotiations are happening in the House and Senate to figure out a deal to reauthorize the subsidies and bring down costs.
But lawmakers are running out of time; open enrollment for coverage ends on December 15. To understand the human stakes of these policy negotiations, I spoke with four people who are facing significant ACA premium hikes and are now considering going uninsured.
Hussein Cabrera, 45, is, ironically enough, an IT contractor for a health insurance company in South Carolina, but because he’s not technically a full-time employee, he doesn’t receive coverage through his work.
He, his wife, and their daughter have gotten insurance through the ACA for the past few years. Last year, the family paid $53 for a plan that covered Cabrera’s wife, who has an autoimmune disease, while he and his daughter were on a separate, even cheaper plan.
But when he logged onto HealthCare.gov this year, he couldn’t believe it: His wife’s plan now costs $285 per month.
“I stopped right there. I didn’t even look for my policy,” he told me. He knew they would struggle to afford her plan alone. Instead, his first stop was the internet. He researched the feasibility of cost-sharing ministries, which he ultimately decided were a bad deal, and crowdsourced other solutions on Reddit, where he posted his dilemma in r/healthinsurance, a subreddit forum. There, he encountered dozens of similar posts from people trying to figure out alternative ways to pay for medical bills or who took the chance on going uninsured.
Cabrera is now contemplating a previously unthinkable choice: To keep his wife’s ACA plan, ensure her access to her doctors and medicines, but let coverage lapse for him and his daughter. The family can no longer afford a second plan for them now that his wife’s coverage is five times as costly as it was in 2025.
Cabrera knows the risks he’s courting, but, he told me, he just doesn’t feel like he has a choice.
“If I cannot get insurance, or if either of us, we’re gonna go back to the old way of doing things. We’re gonna have to go to the emergency room for stupid shit,” Cabrera said.
When I spoke to Cabrera, he expected to go uninsured, along with his daughter, but he won’t make a final decision until next month. Until then, Cabrera is planning to schedule a bunch of appointments and refill his prescriptions before the end of the year, which is when his current coverage runs out.
What’s the plan after that? “Pray and see what happens,” he said.
Ian is 36; living in San Antonio, Texas; and working part-time while also helping take care of his parents, who have serious medical conditions. He has been enrolled in the ACA for most of the past decade, because his employment has been temporary or contractual — working multiple jobs at any given time — including at a local grocery chain and in community relations for the NBA’s San Antonio Spurs, which he told me he just wrapped up.
Last year, he said, he was able to sign up for a health insurance plan that cost him less than $100 per month and had no deductible. But when he checked on next year’s prices, the cheapest plan he could find was $282 per month and came with a $10,000 deductible.
“Do I really need health insurance at this point?” he said when we spoke by phone recently.
But he does need it. Ian told me that he has had asthma for most of his life and, while he’s generally kept it under control, a recent Covid-19 infection has made the condition a daily struggle. He needs medical attention. For each inhaler, Ian might pay $50 or more without insurance — but without an inhaler, his symptoms could get worse and cause permanent damage to his lungs. He coughs several times while we are on the phone.
I asked Ian whether he’ll sign up for health insurance on the marketplace, as he has in the past, or if he’ll go without. “At this point, I’m 50-50, to be honest,” Ian told me.
Texas, his home state, has the highest uninsured rate in the country, and, in an ironic twist, this might work in his favor if he decides to join the ranks. Because so many people don’t have health insurance, the state’s health care providers strive to provide access to some basic services at a lower cost. He’s contemplating whether to use discount drug sites like GoodRx for his albuterol for his asthma; the local hospital system in San Antonio also has a discount patient price program.
But all of his options now are suboptimal. “Health care needs to be fixed,” he said.
Samuel, 47, was a long-time government contractor who had access to good health insurance — about $300 a month for a plan with a low, $450 deductible — through his work before he decided to start his own business in the past year.
But after he went out on his own, it was much harder to find an affordable option. When he logged onto the ACA marketplaces last year, Samuel — who asked me to only use his first name for privacy while sharing personal financial details — signed up for a plan that cost $480 per month with a $7,500 deductible. It wasn’t great, but it was doable.
This month, Samuel logged onto the ACA marketplaces, and the only plans that covered the doctors and hospitals in his local area were both more expensive — now up to $580 per month — and with worse benefits. The deductible would be $8,500.
Samuel is a single guy with no serious health problems; he’s considering whether he could risk going uninsured. But the current moment is forcing people like him to consider some ghoulish scenarios. He reviewed some of the detailed benefits documents for next year’s plans, and he said that, even if he ended up in a car accident, he might not hit his new deductible and end up paying the whole bill out of pocket anyway.
But at the same time, he worries about hospitals being unwilling to treat him if he’s uninsured. (Federal law requires hospitals to care for someone in an emergency, but anecdotal reports of hospitals refusing to follow that rule are not hard to find.)
“I don’t trust the hospital,” he told me. “Most likely, the way I’m looking at it now, because a hospital could potentially deny me service for not having health insurance, that basically forces my hand.”
It’s another impossible dilemma foisted upon him by the US health system. For now, he’s planning to pick up extra work to cover the cost of his health insurance plan. But he’s hoping Congress will act and bring plan costs down before the open-enrollment window closes
When I called Steven, a retiree in his late 50s who lives in New Jersey, he was waiting on an HVAC worker to come and fix his furnace. It had died last week, and, with colder weather on the way, the water pipes were going to freeze soon. “Health care is only part of my aggravation,” he told me.
Up until last year, his family of three was covered by his wife’s insurance, provided by the large corporation for which she worked. It was $500 a month with a low deductible. But then, the company shut down her division, she decided to retire, and the couple and their son enrolled in the same plan on the state’s ACA marketplaces.
They couldn’t get such a great deal, but they found something usable: about $1,000 per month — pricey, but they were able to keep all of their doctors, who were in network. Their deductible was about $4,600.
But next year, their current plan would cost $2,700 every month to keep, and their deductible would be higher — up to $5,300. They could consider dropping their college-aged son off the plan, but he would struggle to afford health insurance on his own, and it would only save his parents $300 a month.
Steven says he feels trapped. Given their age, he and his wife don’t feel they can afford to go without insurance. But they’re now going to have to pull money out of their retirement accounts to cover the cost of their health plan.
“We cannot wing it and not have health insurance,” Steven said. “I’m spending a lot of money that I really do not have on health care.”
He’s done the math. If he kept his same plan, paid all of the premiums, and paid the maximum out-of-pocket costs, he could spend $50,000 on health care out of pocket — even with a health insurance plan.
“It kinda seems like the two political parties want to be right and not care about people,” he told me.
