The looming expiration of Affordable Care Act (ACA) subsidies in December 2025 is casting a shadow of uncertainty over millions of Americans, including Andy Lilienthal, a 47-year-old freelance journalist and marketer. Lilienthal and his wife, who own a small business, currently pay approximately $660 a month for their health insurance thanks to ACA subsidies. However, they are facing a staggering increase to around $1,700 per month by 2026, a cost that would exceed their monthly mortgage in Portland, Oregon. “It’s caused a great amount of uncertainty,” Lilienthal expressed in a recent interview. “It has definitely upped the anxiety levels around here.”
The recent government shutdown further complicated matters. Despite efforts by Democrats to include an extension of ACA subsidies in a spending package aimed at reopening the government, a bipartisan agreement ultimately fell short. Eight Democrats sided with Republican lawmakers to end the record-breaking shutdown, resulting in the signing of a bill that omitted critical health care measures. This development leaves millions of Americans at risk of losing their health coverage or facing exorbitant costs come 2026. According to the Centers for Medicare & Medicaid Services, approximately 24.3 million Americans rely on ACA plans, with around 92 percent receiving some form of subsidy.
Recent research underscores this growing anxiety surrounding health care costs. A West Health-Gallup study found that nearly half of adults surveyed worry they won’t be able to afford health care in the coming year. Shockingly, one in five respondents noted someone in their household had been unable to afford a prescription in the past three months, while 30 percent reported a family member had skipped medical treatment due to cost barriers.
Business owner Alaina Shearer, who runs a boutique advertising agency, shared her own concerns about health care costs. While she doesn’t currently receive ACA subsidies, she is contemplating going without health insurance for the first time in her adult life. Her monthly premium for a family of four is projected to rise from $1,295 to $1,695 in 2026, yet the coverage comes with a significant deductible of $20,000. Shearer, who has been in business since 2009 when she paid only $350 for health insurance, expressed her fears, saying, “It’s hard not to think of myself as failing my family and my kids.”
Similarly, Deborah Kevin, a 62-year-old small business owner from Baltimore, acknowledged that going without health coverage is not a viable option for her age group. Currently paying $365 a month for insurance, she faces a potential increase to nearly $1,600 per month in 2026 without ACA support. “This increase makes us question what kind of care we’ll actually be able to afford,” Kevin said, highlighting the emotional toll the situation has taken. “There’s a quiet kind of stress that comes with running your own company… This health insurance increase makes that weight even heavier.”
The United States remains the only high-income country without universal health care, leading to rising concerns regarding the affordability and accessibility of health services. According to Munira Z. Gunja, a senior researcher at the Commonwealth Fund, the high cost of health care in the U.S. is attributed to a variety of factors, including high service prices in hospitals and a profit-driven insurance model that doesn’t necessarily lead to improved health outcomes for consumers.
As 2026 approaches, the uncertainty and anxiety surrounding health care costs are likely to escalate, affecting not just individual families but the broader business landscape as well. Many are left searching for answers while policymakers consider potential solutions to alleviate the imminent crisis.
