Key Takeaways:
- Millions of middle-class Americans who have Affordable Care Act (ACA) health plans are facing soaring premiums in 2026 due to the expiration of enhanced subsidies.
- Women are disproportionately affected by the premium hikes, as they often make healthcare decisions for their families and use more healthcare services than men.
- Families are being forced to make tough choices, such as dropping coverage, switching to less comprehensive plans, or taking on part-time jobs to qualify for employer-sponsored health benefits.
- The premium hikes are affecting not only individuals but also families, with some having to dip into retirement savings or make significant lifestyle changes to afford healthcare.
- The situation is particularly challenging for freelancers and self-employed individuals who rely on the ACA marketplace for health insurance.
Introduction to the Problem
As the clock ticked down on 2025, many Americans were agonizing over their family’s insurance options. With the expiration of enhanced subsidies for Affordable Care Act (ACA) plans, millions of middle-class Americans were facing soaring premiums in 2026. This was the case for B., a woman from Providence, R.I., who had lost her job as a nonprofit manager and was struggling to find a new full-time job with benefits. Her family’s "gold" plan cost them nearly $2,000 a month in premiums, which was already a significant burden. However, with the subsidies expiring, their premium would increase to almost $3,000 a month, making it unaffordable for them.
The Disproportionate Impact on Women
Women are disproportionately affected by the premium hikes, as they often make healthcare decisions for their families and use more healthcare services than men. According to Elizabeth Tobin-Tyler, a professor at Brown University School of Public Health, women generally use more healthcare than men, in part because of their need for reproductive services. Additionally, women tend to be the medical decision-makers for the family, especially for the children. This means that they are often responsible for navigating the complex healthcare system and making difficult decisions about which plans to choose and how to afford them.
The Challenges Faced by Freelancers and Self-Employed Individuals
Freelancers and self-employed individuals are particularly vulnerable to the premium hikes, as they rely on the ACA marketplace for health insurance. Cynthia Freeman, a 61-year-old performer from Brooklyn, and her husband Brad Lawrence, a 54-year-old woodworker, are facing a 75% increase in their monthly premiums in 2026. Lawrence was recently diagnosed with kidney disease, and their current "silver" plan will no longer be affordable for them. Freeman has had to take on a part-time bartending gig to help pay for their health insurance coverage, and is considering applying for a full-time bartending job at a hotel chain that comes with health benefits.
The Impact on Families and Relationships
The premium hikes are not only affecting individuals but also families and relationships. Nicole Benisch, a 45-year-old holistic wellness business owner from Providence, R.I., has put her marriage plans on hold due to the significant increase in her premium costs. As a married couple, their combined income would exceed 400% of the federal poverty level, making her ineligible for any financial help with coverage. Benisch is faced with the difficult decision of either switching to her fiancé’s health plan in Massachusetts, which would mean losing her Rhode Island doctors, or maintaining her current plan and paying a significantly higher premium.
The Consequences of Inaction
The consequences of inaction are severe, with families being forced to make tough choices, such as dropping coverage, switching to less comprehensive plans, or taking on part-time jobs to qualify for employer-sponsored health benefits. B., the woman from Providence, R.I., has had to dip into her retirement savings to pay for her family’s healthcare costs and is still struggling to find a new full-time job with benefits. The situation is a stark reminder of the need for affordable healthcare options and the importance of addressing the root causes of the premium hikes.
Conclusion
In conclusion, the expiration of enhanced subsidies for ACA plans has left millions of middle-class Americans facing soaring premiums in 2026. Women, freelancers, and self-employed individuals are disproportionately affected, and families are being forced to make difficult choices to afford healthcare. The situation is a wake-up call for policymakers to address the root causes of the premium hikes and ensure that affordable healthcare options are available to all. As the healthcare landscape continues to evolve, it is essential to prioritize the needs of those who are most vulnerable and work towards creating a more equitable and sustainable healthcare system.