SUGAR GROVE, N.C. — Ross and Rebecca Tobiassen have faced a troubling trend over the years as their healthcare costs continued to rise. Relying on the Affordable Care Act for subsidized health insurance since its inception in 2014, the couple believed the peace of mind was worth the increasing cost. However, that sentiment took a dramatic turn in December when they opted to cancel their insurance due to skyrocketing premiums, with fees increasing from $130 to more than $550 monthly.
Rebecca expressed her frustration, stating, “It makes no sense. It’s not worth it anymore.” The Tobiassens operate a small auto shop near Appalachian State University, making them acutely aware of the risks associated with Ross’s work as a mechanic. Past accidents, including a metal ball joint shooting into their wall and severe injuries to Ross’s thumb and eye, have underscored the importance of health coverage. Ross, who is now mostly blind in one eye due to prior workplace injuries, highlights the precarious balance between their business and health needs.
The couple’s decision reflects a broader trend among Americans abandoning their ACA coverage after Congress allowed enhanced tax credits—designed to ease the financial burden— to expire at the end of 2025. Millions are projected to lose their health insurance, with a recent analysis indicating a potential drop in ACA enrollment from over 22 million to as low as 16.5 million by 2026.
In North Carolina specifically, sign-ups for individual ACA plans saw a staggering decrease of 22% compared to the previous year, representing more than 213,000 individuals. Rebecca criticized the federal government’s apparent disregard for families like hers, stating, “We’ve known that you don’t care about us, but you’re making it plain and simple now.”
Despite the ACA’s purported benefits, the Tobiassens have found that their insurance did not cover all their medical costs adequately. Five years ago, when Ross’s eye problems worsened, they learned that the necessary surgery would cost them around $30,000, forcing Ross to seek a less expensive treatment option. The couple is acutely aware of the risks they now face without insurance and the potential for catastrophic medical bills should an emergency occur.
Katie Alexander, who oversees volunteers for Pisgah Legal Services, noted that she has seen an alarming number of clients—from a variety of backgrounds—drop their insurance this year. Many of these individuals include gig workers, part-time employees with chronic illnesses, and those unable to secure adequate coverage through employment. Alexander echoed the worrying sentiment many feel: a nagging sense of anxiety about the cost of getting sick or injured without insurance.
Healthcare premium and deductible rates have skyrocketed since 2022, severely impacting families’ ability to maintain coverage. When the Tobiassens first signed up for ACA plans, their monthly premium was approximately $30, an amount that now feels like a distant memory. Over the years, they acclimated to increasing costs, ultimately considering bronze plans, which offer basic coverage but substantial out-of-pocket expenses.
Healthcare policy researchers point out that without subsidies, such plans are often out of reach for average working families. The erosion of the risk pool due to healthy individuals dropping out could lead to increased premiums for those who remain insured, thus creating a so-called “death spiral” in health insurance markets. Taxpayers, too, face burdens; estimates suggested a $350 billion cost over the next decade attributable to these coverage strategies without reform.
After more than a decade of reliance on ACA coverage, the Tobiassens have decided against returning to the marketplace. They explored alternative options, including a faith-based healthcare organization, but ultimately chose to go without insurance altogether. In light of their situation, they’ve begun to set aside savings for potential medical emergencies, while also keeping credit cards and family support as backup plans.
As health insurance costs continue to rise and more individuals make the difficult choice to forgo coverage, the implications for families like the Tobiassens loom large, highlighting the precarious intersection of healthcare access and financial stability.
