At a time when affordability is dominating political discussions, the escalating cost of health care presents a growing challenge for many Americans. This is especially pressing for those concerned about paying insurance premiums after the end of expanded Affordable Care Act subsidies. Yet, they are not alone in facing these difficulties. Stephanie Sy provides more insight.
Amna Nawaz:
With affordability under the spotlight, increasing health care expenses are becoming a significant worry for numerous Americans, particularly for those anxious about covering insurance premiums following the expiration of the Affordable Care Act’s subsidy expansion.
However, this problem extends beyond just those individuals.
Stephanie Sy sheds light on this issue.
Stephanie Sy:
A recent survey conducted by the West Health-Gallup Center found that one-third of Americans are forced to make difficult compromises to manage health care costs, including skipping meals, cutting back on driving, or borrowing money. The poll included 20,000 adults.
Many facing financial strain lack insurance, and with the previous ACA subsidy increase ending last year, that figure is rising. We spoke to some Americans relying on Obamacare who are now grappling with higher premiums and reduced support.
Brian Lantier, New York Resident:
My name is Brian Lantier, and I live in New York City.
Micheline Pierrette Berry, California Resident:
I’m Micheline Pierrette Berry from Santa Monica, California.
Brian Lantier:
My plan or premium expired around December 15. That was the deadline to renew, which I did not do for 2026.
Micheline Pierrette Berry:
Previously, I had a Silver plan costing $236 monthly. This year, that same plan is $360 per person.
Brian Lantier:
After tax credits, my premium was about $390 per month, but now it’s gone up to approximately $770. Naturally, I’d feel better with insurance, but I recognize I’m fortunate to be a healthy 54-year-old who doesn’t smoke, has a normal BMI, and no chronic health conditions.
I know that most people aren’t in such a fortunate position.
Micheline Pierrette Berry:
As a cancer survivor, the ACA gave me access to excellent care when I was diagnosed and the necessary follow-up treatment.
Brian Lantier:
Since I am relatively healthy with no chronic conditions and take no medications, I’m not reliant on insurance. But I saw my mother require multiple expensive hospital visits during her last months, which highlighted the high cost of care.
Micheline Pierrette Berry:
Unfortunately, quality care without insurance is subpar. Even if I have to borrow money, remaining on my plan is essential because my health depends on it.
Brian Lantier:
If something happens, my plan is to pay out of pocket. For now, I’m essentially self-insuring.
Micheline Pierrette Berry:
I hope that, through enough advocacy and legislation, healthcare subsidies will become less politicized and more of a fundamental human concern addressed by current and future administrations.
Stephanie Sy:
Polls reveal that rising healthcare expenses affect not only those on government-subsidized plans but also people with employer-sponsored insurance.
This comes amid efforts by the president and a Republican-led Congress to reduce program funding. Although some progress has been made to lower prescription drug prices, the impact has been limited.
To discuss the wider implications, I’m joined by Larry Levitt, executive vice president for health policy at KFF.
Larry, thank you for being here.
It’s been several months since projections showed at least two million Americans would lose the expanded ACA subsidies. According to the Wall Street Journal, 14 percent of ACA enrollees missed their payments in January.
What can you tell us about these individuals and the effect on patient health?
Larry Levitt, Executive Vice President For Health Policy, KFF:
Yes, those individuals are making difficult decisions, much like the people you interviewed.
After the end of expanded premium subsidies, about one million fewer people enrolled in coverage. However, many who did sign up chose not to pay their premiums when bills arrived in January.
Our polling found similar patterns: people reporting sharply increased costs and being forced either to cut household spending or forgo insurance altogether.
Stephanie Sy:
With a Republican-led Congress currently unwilling to restore these subsidies, what might this mean going forward?
Larry Levitt:
We can reasonably expect that high out-of-pocket premiums will continue throughout the year without subsidy reinstatement.
Congress could still extend these subsidies retroactively, but given ongoing partisan disagreement, progress seems unlikely.
Stephanie Sy:
How does this connect to the expiration of the ACA’s expanded subsidies?
Larry Levitt:
The majority affected are low- and middle-income individuals relying on ACA subsidies or Medicaid coverage.
Last year, Republicans passed the “One Big Beautiful Bill,” which includes nearly a trillion dollars in Medicaid cuts spanning a decade—the largest federal healthcare rollback ever. Most cuts will take effect gradually.
Starting January 1, new Medicaid work requirements came into effect, potentially causing millions to lose insurance due to non-compliance, failure to qualify for exemptions, or administrative hurdles.
Stephanie Sy:
As costs rise across Medicaid, ACA plans, and employer coverage, KFF research indicates troubling trends. Are we facing a critical point where millions could lose coverage?
Larry Levitt:
It’s challenging to pinpoint a tipping point—concerns about healthcare affordability have been longstanding, voiced by every recent president.
Nonetheless, affordability worries are widespread; health care consistently ranks as a top economic concern. Beyond Medicaid and ACA, 160 million Americans with employer-based insurance are also seeing premium increases, along with steadily rising deductibles averaging nearly $1,900 per person.
Stephanie Sy:
The issue extends beyond prescription drug costs to hospital care expenses. Politicians and industry players often blame each other, making solutions elusive.
How can progress be made?
Larry Levitt:
There’s plenty of responsibility to share. While drug prices are notably higher in the U.S. than other countries, they represent a smaller fraction of healthcare spending.
Hospital care, especially hospital pricing, drives much of the recent cost growth—accounting for 40 percent of increases.
Insurers also contribute; 15 to 20 cents of every premium dollar cover overhead and profit, an area attracting mounting scrutiny.
Overall, the U.S. spends nearly twice as much as other wealthy nations on health care yet obtains poorer results, including lower life expectancy and incomplete coverage.
Unlike other countries, the U.S. relies heavily on for-profit insurers and has weaker regulation of drug and hospital pricing.
Stephanie Sy:
This is Larry Levitt from KFF.
Thank you very much for sharing your expertise, Larry.
Larry Levitt:
Thank you for having me.
Original article: www.pbs.org
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