Stacey Hilton’s Health Insurance Concerns
Stacey Hilton faces a daunting reality: she won’t qualify for health insurance in 2026.
At 55, this registered nurse from West Michigan finds the situation alarming, yet she justifies it due to escalating health insurance costs.
Hilton is aware of her high blood pressure and fibromyalgia. But what truly worries her are the unforeseen challenges that might come next year.
“I focus on my health by sleeping well, eating right, exercising, and generally taking care of myself,” said Hilton, who works part-time in two facilities in Muskegon.
“So far, we’ve gotten through this year without any major disasters.”
In 2025, she was among over 24 million Americans who secured health insurance through the Affordable Care Act (ACA) marketplace, yet she, like many others, has seen her out-of-pocket expenses rise dramatically as COVID-19-related subsidies came to an end.
Individuals utilizing the ACA tend to be self-employed, small business employees, part-time workers, students, early retirees, or those without jobs.
Tax credits offer some relief for households with incomes between 100% and 400% of the federal poverty line, which in 2026 is set at $15,960 for individuals and $33,000 for families of four.
These tax credits expanded during the pandemic, making more individuals eligible for help with premiums. However, assistance initiated in 2021 is set to expire at the end of December 2025.
Federal lawmakers have debated extending these subsidies or finding alternative relief methods, but no consensus has been reached, leading to anticipated premium increases in 2026.
A nonprofit organization in San Francisco calculated that Hilton’s monthly payment could jump to around $800, effectively doubling her costs.
“This is the first year I’m without health insurance,” Hilton shared.
“In a country with so many resources, it’s unacceptable for anyone to go without the healthcare they need or to worry about financial ruin because they can’t access treatment.”
As of late January, nearly 497,064 residents in Michigan were enrolled in plans through the healthcare marketplace, about 34,000 less than the previous year. Nationwide, enrollment has dropped by over 1 million—the lowest seen since 2020.
A recent survey revealed that two-thirds of respondents nationwide express significant concern over their ability to pay medical bills, a greater worry than issues related to utilities or food.
However, the complete landscape of ACA enrollment will only become clear later this year as unpaid premiums will alter actual enrollment figures.
Health Coverage Alternatives
Kendra Bonga, a self-employed home decor retailer from Grand Rapids, found a plan within her 2026 budget after some searching through the ACA Marketplace.
Previously, she paid about $180 monthly for a Blue Cross Blue Shield plan that allowed her to attend weekly medical and therapy appointments. In 2026, this plan would cost her $585 a month, double the deductibles, and it wouldn’t include coverage for her chosen therapist.
At 45, Bonga secured a different plan with slightly lower payments but much higher deductibles, costing her about $600 more annually. Despite limited in-network options, she felt it was a fair trade since her current provider was included.
“I’m just relieved it didn’t increase further,” she said. “Still, I can’t shake this uneasy feeling. I keep wondering what happens if I need care outside of what’s offered by Mercy or Pinerest.”
In 2010, when lawmakers implemented the ACA, the goal was to enhance access to affordable health insurance.
This law succeeded in decreasing the uninsured rate among those under 65, dropping from 17.8% in 2010 to 10.9% by 2015 and remaining stable over the following decade.
Dr. Mark Fendrick, a physician and professor at the University of Michigan who contributed to drafting the ACA, notes that affordability remains a significant issue.
“Many people have insurance but are underinsured,” he explained, citing years of research on health insurance and medical expenses.
Fendrick expressed alarm at the prospect of many going completely uninsured again in 2026, feeling as if the progress made has unraveled.
“It’s like stepping back in time,” he remarked. “I never expected to see these challenges resurface.”
What to Do If Insurance Is Unaffordable
Fendrick acknowledges the challenge for many trying to find thousands for deductibles, even when selecting the cheapest plans available.
But this concern pales against the staggering costs uninsured individuals can face after unexpected medical issues arise.
“Even if people may heal physically or mentally from such crises, the financial burden can have lifelong repercussions,” he remarked. “Having some insurance, even minimally, is vital for protection against disastrous events.”
If insurance proves unaffordable, alternatives exist.
Most major health systems in Michigan offer financial assistance programs. Fendrick recommends that patients communicate their financial constraints with their providers, who might guide them toward cost-effective options.
“Don’t delay care. Remember that negotiations are an option,” he advised.
In Michigan, resources provide free or low-cost care for uninsured individuals. For instance, community health centers often set fees based on income and refer patients to other low-cost providers.
Many local health departments also provide free vaccinations and health screenings for various conditions.
Organizations like the Patient Assistance Network offer financial support for numerous chronic illnesses, while GoodRx helps with prescription discounts and access to affordable medications.
A Need for Change
The issue of rising health care costs transcends the ACA.
Randy Boyd was stunned when her family’s premium soared from $160 to $328 weekly, despite having coverage through her employer, Amazon.
She described the yearly spikes as “highway robbery.”
“We are already struggling to manage our grocery expenses,” she expressed.
The complexities of rising healthcare costs necessitate a significant shift in approach, Fendrick noted, advocating for a transition from a fee-for-service model to one that values healthy outcomes.
“The challenge lies in altering a system where clinicians get paid based on what they set, regardless of effectiveness,” he said.
Fendrick illustrated this by comparing it to how golfers should be compensated for scoring rather than merely swinging.
Furthermore, he made a light-hearted remark, “You’d never ask a barber if you need a haircut.”
“Given our health investments, if we were achieving top outcomes, it would justify our spending,” he reflected while referencing the ongoing Winter Olympics and healthcare expenditures.
“But here we are, spending significantly without even approaching the podium, highlighting the need for further improvement.”
As for Hilton, she doesn’t know what 2026 will entail. There’s a hope for temporary insurance if she can work as a travel nurse, though that outcome isn’t certain.
The pressing question looms large for her: “What if?”
What if a cardiac event strikes or if she develops a serious illness and lacks coverage for the astronomical costs?
“I just hope this year remains uneventful without significant issues that would leave me unsupported,” she concluded.
