Health Insurance Dilemmas Prompt Couples to Go Uninsured

Ginny Murray and her husband, Chaz, are facing a tough decision about health insurance. With premiums projected to hit record highs in January, they find the costs out of reach.

This Arkansas couple plans to drop their insurance entirely, relying on savings to manage any unexpected health issues. “We’re aiming to save the money we currently spend on healthcare since the Affordable Care Act covers us, and just hoping we don’t face a major health crisis,” Murray noted.

This situation reflects a wider trend as enhanced subsidies for ACA premiums are set to expire at the end of the year. Without these subsidies, many Americans might see their monthly premiums skyrocket, prompting them to rethink their healthcare options or even whether insurance is worthwhile.

Art Caplan, a medical ethics director at NYU, predicts that premium increases next year will be the steepest since the ACA launched. While open enrollment for ACA plans starts next month, it’s unclear how many people will opt out of insurance. The Congressional Budget Office anticipates that nearly 4 million individuals could lose their coverage when the subsidies end, leading to deadlock in Congress about extending tax credits.

For Murray, currently 48, the situation is complicated. She’s unable to work full-time after a serious work-related injury and is receiving workers’ compensation. Chaz continues to work as an independent truck driver.

The couple faces a steep monthly premium — around $1,500 for both — but with subsidies, it’s about $450. However, regulators recently approved a 26% hike for insurers, meaning an increase of at least $400 in the coming year. Without the subsidies, costs could more than triple.

“What alternatives do we even have?” Murray asked.

“A Catastrophic Event”

Choosing to be uninsured isn’t a new phenomenon. Before the ACA was enacted in 2010, countless Americans took similar risks, often with dire financial repercussions, said Dr. Adam Gaffney of Harvard Medical School.

Data reveals that from 2010 to 2023, the uninsured rate plummeted from about 16% (about 48 million people) to 7.7%. The number participating in ACA plans has surged from 8 million in 2014 to a peak of 24.3 million in 2025, partly due to more robust subsidies.

Gaffney remarked, “Unless you’re very affluent, it’s nearly impossible to save enough to cover a major health crisis. For the uninsured, financial ruin can come from just one severe illness or accident.”

Joan Volk from Georgetown University’s Center on Health Care Reform indicated that the situation is aggravated by the reality that many Americans lack a financial cushion. Approximately 37% of adults might struggle to manage a $400 emergency expense in 2024.

Even for those aiming to save, the financial cushion often pales against the costs of standard medical procedures, she added.

“I think people are trying to save money,” Volk reflected. “But I’m not sure how many are fully aware of the costs they might face without insurance.”

“The Situation is Only Going to Get Worse.”

Donnell Dowis, a Denver resident, understands how fast unexpected medical costs can sum up. She recalls her father’s appendectomy in the ’90s as a significant financial strain for her family.

“It was a struggle for us back then,” Dowis shared. “That fear from childhood never quite goes away.” Yet, she and her husband, Christopher, plan to forego ACA coverage next year in favor of building a high-yield savings account.

Both in their 40s and managing a web development business, they currently pay about $600 in premiums, which could jump to $1,300 next year.

Keeping insurance could mean sacrificing care for their two aging dogs, who both have cancer, as well as cutting back on retirement savings and family visits. “We’re going to have to reduce spending on things I consider essential, but I’m not sure I can really commit to that at this age,” Dowis mentioned.

Feeling healthy now, they believe they can manage without insurance for the time being. Still, Dowis expressed, “I’m pretty frustrated and honestly angry. We’ve spent years trying to fix this situation, and it seems to be getting worse.”

Claire Esparros, a 34-year-old freelance photographer from New York City, experiences a similar cycle of anxiety when renewing her ACA insurance and grappling with higher monthly payments. She primarily relies on her coverage for routine checkups and occasional visits, but has found the benefits lacking.

“It’s really not a great plan,” she commented. Currently holding a catastrophic plan with a hefty deductible of nearly $10,000, she said her only reason for keeping it is to prepare for the worst.

Next year, however, she plans to let the insurance lapse as her monthly premium is set to soar from about $300 to $900. “I can’t justify that kind of expense anymore,” she admitted.

Instead of establishing a savings account like the Murrays and Dowises, Esparros is contemplating forming a medical co-op where members share costs for medical expenses.

Caplan noted that these co-ops, or community-based self-insurance models, can be more affordable and flexible, particularly for healthy individuals. However, they aren’t regulated under the ACA which means they might face limitations and risks, including the potential of being financially crippled by one costly lawsuit.

Esparros mentioned she’s weighing a couple of options, feeling a sense of security in the co-op idea. “It feels more personal and safer,” she said.