If Congress doesn’t intervene soon, as many as 4 million people in the U.S. could become uninsured due to the rising costs of health insurance premiums.
After lengthy negotiations, Congress reached an agreement to end a government shutdown that was unprecedented in its duration. Throughout this process, Democrats pushed for lower health insurance premiums, yet they ultimately compromised without securing changes that would prevent what many see as an imminent crisis in healthcare policy. It’s crucial now for lawmakers to come together on a solution that safeguards millions who depend on the Affordable Care Act’s marketplaces, especially given the projected average premium hikes of 30% for the next year.
Insights from interviews with those facing losing insurance
- vox Conversations with a diverse group, including gig workers, fathers, early retirees, and midlife entrepreneurs reveal tough choices ahead as healthcare expenses rise.
- Many are considering cutting back on healthcare, skipping appointments or medications, and some may end up uninsured entirely.
- There’s a prevailing sense that politicians are more interested in political gain than resolving the healthcare crisis.
If lawmakers fail to act, insurance premiums could skyrocket to five to six times what some paid last year.
There are over 20 million folks buying plans in the marketplace, but many are now grappling with shockingly high costs, or even losing financial support, which has made insurance unaffordable.
The Democratic Party is pushing Republicans to agree on a vote by mid-December to restore national health insurance subsidies as part of lifting the shutdown. Negotiations involving both parties are currently in progress in Congress aiming to decrease these healthcare costs.
However, time is running short. The open enrollment period ends on December 15th, and to highlight the impact of these negotiations, I spoke with four individuals who are facing substantial increases in their insurance premiums and are contemplating going uninsured.
Hussein Cabrera, 45, is a contractor in South Carolina for a health insurance company—yet ironically, he doesn’t receive health coverage through his job since he isn’t classified as a full-time employee.
For several years, he and his family have been insured via the ACA. Last year, the family paid just $53 for his wife’s plan—she has an autoimmune condition—while he and his daughter opted for a more economical option.
But this year, when he checked healthcare.gov, he was hit hard. His wife’s plan is now a staggering $285 a month.
“I just stopped looking,” he admitted. The thought of shouldering that financial burden for his wife’s care alone felt overwhelming. Instead, he turned to the web and explored alternatives. He even posted his situation on Reddit, hoping to crowdsource some solutions. There, he found many others like him seeking ways to manage their healthcare costs.
Cabrera is now weighing options he never thought he’d consider. To keep his wife’s plan, he might have to drop coverage for himself and their daughter just to ensure she has access to necessary medical care. With his wife’s premiums having increased fivefold for 2025, another plan is no longer financially viable for the family.
He recognizes the risks involved but feels trapped. “Without insurance, we’ll probably end up back in emergency rooms for minor issues,” Cabrera said.
While he anticipates opting out of coverage with his daughter, he holds off on a final choice until next month. For now, he plans to arrange appointments and refill prescriptions before the current insurance lapses.
What comes after that? “We’ll just have to see,” he said, invoking a hope mingled with uncertainty.
Ian, a 36-year-old from San Antonio, Texas, has been juggling part-time work while caring for aging parents with serious health issues. Enrolled in the ACA for much of the last decade due to his fluctuating job status, he has held various roles, including a position at a local grocery store and as a community worker for the NBA’s San Antonio Spurs.
Last year, he managed to secure a no-deductible health plan for under $100 monthly. Now, reviewing the upcoming year’s options, the least expensive plan he found was $282, featuring a staggering $10,000 deductible.
“Is health insurance even essential for me at this point?” he mused during our conversation.
Yet the answer is complicated. Ian has struggled with asthma his entire life, and recent bouts of illness have intensified his need for medical attention. An inhaler can cost over $50, and without one, his condition worsens, and serious complications could arise. He coughed frequently as we talked, underscoring his struggle.
I asked Ian if he was inclined to enroll in a Marketplace plan like before, or if he feels he might skip it this time. “Honestly, I’m really torn,” he admitted.
Living in Texas, which has one of the highest uninsured rates in the nation, he noted that this might work in his favor should he end up joining that group. Many healthcare providers in the area are motivated to keep costs low to serve the uninsured. He’s considering options like using discount services such as GoodRx to manage his asthma treatment. The local healthcare system even offers a patient pricing program for those in need.
Still, he’s aware that none of his current paths are ideal. “Healthcare really needs to get better,” he remarked.
Samuel, 47, who previously worked as a contractor, had access to excellent health insurance during his employment, which was about $300 monthly with a low deductible. After deciding to start his own business last year, he found everything changed drastically.
When he logged into the ACA Marketplace last year, he had to settle for a $480 plan that included a $7,500 deductible. It was far from perfect, but manageable given his situation.
This month, he returned to the Marketplace, but the only plans available covering local providers are now priced at about $580 monthly, with significantly worse benefits and an $8,500 deductible.
Despite being a generally healthy individual, Samuel now finds himself considering the risks of going uninsured. The looming possibility of an accident or illness weighs heavily on him. He reviewed some fine print and recognized that even a minor emergency might have him facing steep out-of-pocket expenses if he doesn’t meet the hefty deductible.
At the same time, he worries about being turned away from care if he can’t show proof of insurance. “I don’t trust hospitals,” he said. “I fear that they’ll deny treatment because I lack coverage, which leaves me feeling quite powerless.”
Samuel is facing one of many tough dilemmas brought on by the healthcare system. For now, he’s considering taking additional work just to cover insurance expenses. He remains hopeful that Congress will step in to alleviate costs before the enrollment period concludes.
I connected with Stephen, a retiree in his late 50s living in New Jersey, who was also in a challenging situation. He was waiting for an HVAC repairman to deal with a furnace issue, worried about how much worse things could get as temperatures drop. “Healthcare is just one piece of a much larger puzzle for me,” he explained.
Until recently, his family relied on insurance from his wife’s former employer, which cost them roughly $500 monthly with a low deductible. But after her job ended, he and his family switched to a plan on the ACA marketplace.
Their new plan was costly at about $1,000 a month, but it allowed them to keep their preferred medical providers with an approximate deductible of $4,600.
Next year, however, retaining this coverage would jump to $2,700 a month, with an even higher deductible reaching $5,300. They’ve thought about removing their college-aged son from the plan, yet this would only save them about $300 monthly, which isn’t enough to make a difference.
Stephen feels trapped, acutely aware that at his age, both he and his wife might struggle without insurance. He’s now contemplating tapping into retirement funds to manage his insurance payments.
“We’re in a tight spot because we lack health insurance,” Stephen shared. “We find ourselves spending money that isn’t exactly on healthcare.”
He calculated that by maintaining his current plan, covering all premiums, and hitting his out-of-pocket maximum, he could end up spending around $50,000 on medical expenses, despite technically having insurance.
“It feels like neither party is genuinely concerned about people’s struggles—they’re just interested in winning,” he remarked.
