When Kassidy Hooter discovered in December that her health insurance costs would significantly increase in the coming year, she found herself in a state of alarm. The Shreveport, Louisiana, resident, who is currently in the final trimester of a high-risk pregnancy, faced the harsh reality that her family’s Affordable Care Act (ACA) coverage was becoming unaffordable due to the expiration of a vital federal tax subsidy. This subsidy, which expired on December 31, 2025, would potentially hit their finances with thousands of dollars in additional out-of-pocket expenses.
“We heavily considered that it might just be cheaper to give birth at home,” Hooter shared, expressing the distress such financial pressures brought upon her family. Ultimately, she resolved to forgo insurance completely.
To ease her immediate burden, a local medical center stepped in, offering three months of financial aid to cover her medical expenses leading up to her due date in February and extending into late March. After this period, Hooter anticipates managing her medical costs independently, with the hope of enrolling her newborn in Medicaid swiftly—a government health program designated for low-income Americans.
“I’m just hoping for the best,” Hooter remarked, voicing her concerns about her family’s future health and financial security.
The impact of ACA’s changes is emblematic of a larger trend highlighted by Nima Sheth, vice president of health justice at the National Partnership for Women and Families. Since the ACA’s introduction in 2010, the uninsured rate in the U.S. had dropped from approximately 15% to 8%. However, experts warn that the number of uninsured Americans could drastically rise if Congress fails to address the needs of the 22 million individuals who benefited from these tax credits. The Congressional Budget Office has projected a potential increase of 3.8 million uninsured Americans annually from 2026 to 2034 if the credits are not extended.
Many Americans face a deadline soon; most states provide until January 15 for enrollment in ACA marketplace plans. The expiration of the tax credits has resulted in predicted premium hikes averaging 114% for those who previously relied on these subsidies, according to data from KFF, a health policy research organization.
“What we’re seeing here is a policy choice,” Michelle Sternthal, interim senior director of policy and strategy at Community Catalyst, pointed out. “It’s, in effect, turning insurance into a luxury item and medical debt into the default.”
In a legislative move last Thursday, the House of Representatives approved a three-year extension of the expired ACA tax credits. However, it now faces significant challenges in the Republican-controlled Senate, where lawmakers express cautious optimism that it could serve as a foundation for a compromise to preserve some form of the credits.
Stacy Kanas, a resident of Plantation, Florida, related her own experience as she grapples with the implications of the tax credit expiration. Initially benefiting from ACA subsidies, Kanas is contemplating going uninsured after learning that her monthly premiums would soar to $2,500, more than double what she paid last year for coverage that included her husband and their college-aged daughter. “It’s weighing extraordinarily heavily on me,” Kanas shared, reflecting on the financial risks that could arise from such a decision.
Although Kanas considers herself healthy, she worries about the repercussions of being uninsured—a potential vulnerability that could lead to catastrophic financial consequences in the face of a medical emergency.
Experts note that even those who maintain their ACA coverage may avoid necessary medical care to escape elevated out-of-pocket costs. “If you’re underinsured and you have high deductibles, the coverage you’re getting is designed to dissuade getting care, including preventative care,” Sternthal explained.
Personal accounts, such as that of Robert Myers, illustrate the troubling trend. The 31-year-old switched from a silver ACA plan, which would have increased his premium from $17 to $400 monthly, to a bronze plan with no monthly premiums. However, the new plan carries hefty co-pays and an $8,000 deductible, leading him to plan fewer doctor visits. This behavior can result in an increased reliance on emergency care, reflecting a concerning pattern that can amplify both personal health risks and overall healthcare costs in communities.
The situation exemplifies a broader systemic issue. According to experts, delaying necessary care often confines families to financial and health decisions that not only jeopardize their well-being but also reverberate through local economies. “Every delay locks families into decisions that harm their health and their financial stability,” Sternthal noted, pointing out how these issues could impact the wider community.
