Millions of Americans Are Paying for Health Insurance But Can’t Afford to Get Sick
Tax credits the GOP let expire made real insurance affordable. Now, many are going without or buying plans that don't cover much.
By Chiquita Brooks-LaSure
As President Donald Trump prepares to deliver his State of the Union address, the administration is touting a new healthcare plan it says will lower costs. But the proposals announced so far leave untouched the expiration of enhanced Affordable Care Act tax credits — the policy that made coverage affordable for millions and whose loss families are already paying for.
ACA open enrollment has closed. The deadline has passed for Americans to make hard healthcare choices — which plans they could afford and what risks they are forced to accept. Now, the consequences of higher costs and congressional inaction are coming into focus.
Over a million fewer people signed up for ACA Marketplace coverage this year compared with last year. And millions more across the country are insured but not protected.
While we await final enrollment data from the Centers for Medicare & Medicaid Services, several states report a troubling pattern. In California, Idaho, Maine, and Rhode Island, thousands more families switched to health plans that don’t actually meet their medical needs. Not because they wanted bare-bones coverage but because it was all they could afford. When premiums rose and subsidies shrank, people responded the only way they could: by choosing plans with higher deductibles (averaging nearly $7,500), fewer benefits, and far greater financial risk.
ReShonda Young, a small health food store owner, enrolls in coverage because she has cancer — going without insurance simply isn’t an option. In 2025, her gold plan premium was $94 per month. This year, after the enhanced tax credits expired, that same plan would have cost $592 per month — nearly $6,000 more over the year. Unable to afford that increase, she dropped to a bronze plan to keep her monthly premium manageable. But in doing so, her deductible jumped from $1500 to $7,500, and her out-of-pocket maximum rose to $10,000. Every time she needs care, it now costs more; a routine doctor’s visit that cost $15 last year is $50 today – or $100 for a specialist.
I also heard from Ellen Allen, a 64-year-old West Virginian who worked her entire life with the security of employer-sponsored health insurance. When she changed jobs in 2023 to work for a small organization that couldn’t afford to offer coverage, she enrolled through the ACA Marketplace. Last year, with the help of premium tax credits, she paid about $480 a month for a bronze plan. This year, after those credits expired, her premium jumped more than 300% — to nearly $2,000 a month — and she had to drop vision and dental coverage just to stay insured. Allen manages chronic conditions and expects to hit her out-of-pocket maximum. Before she becomes eligible for Medicare in eight months, she will have spent more than $25,000 on healthcare.
These individual decisions add up. Early enrollment data show fewer people signed up for marketplace coverage than last year, with enrollment declining by 1.3 million from last year’s open enrollment. That’s not because they stopped needing healthcare. It’s because affordability was taken off the table. When coverage becomes too expensive or too inadequate, people step outside the system and hope they don’t get sick.
This shift didn’t happen by accident. Last year, congressional Republicans passed — and Trump signed — a tax law that cut more than $1 trillion from Medicaid and the ACA Marketplaces to finance tax breaks for corporations and the wealthiest Americans. Republicans then chose not to renew enhanced ACA tax credits that had made coverage affordable for millions of working families.
The increased costs ripple across the entire healthcare system. Delayed care leads to worse outcomes. Emergency rooms see more uncompensated care. Hospitals and clinics face added strain. Providers spend more time managing financial crises and less time delivering care.
The ACA was built on a simple principle: Coverage should be affordable and meaningful. The enhanced tax credits brought us closer to that promise. They allowed families to choose plans that actually covered the care they needed, stabilized insurance markets, and helped the country reach the lowest uninsured rate in history.
Those enhanced credits weren’t a giveaway. They were tax breaks like those provided for every person with employer coverage — lowering costs so coverage is meaningful and markets remain stable.
Letting the enhanced tax credits expire moved us in the wrong direction. It didn’t lower healthcare costs – it simply shifted them onto working families.
No American should have to choose between a plan they can afford and care they might need to survive. No cancer patient should be insured in name only. And no family should be locked into a year of coverage that leaves them one illness from financial ruin. A healthcare system that forces people into plans that don’t protect them is not working. Americans deserve better than insurance that fails when they need it most.
Chiquita Brooks-LaSure is a former Centers for Medicare & Medicaid Services administrator.
And yet, so many of these people either don't vote at all or vote fascist.
A really sad situation that all Americans aren’t offered an insurance plan they can afford. My husband and I are paying an extra $200 per month for our health insurance. This is because his employer changed the plan we had to a plan that was only for single people with dependents but they didn’t replace the one we had with something else.
I have no issues with them offering a plan for single people with or without dependents but ours should have been replaced with something comparable to what we had.