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We fight, We win, Am Yisrael Chai
"The overall average increase in underlying individual market premiums for people who weren't subsidy-eligible in 2025 was a little more than 25% nationwide," Norris said. "So this family's experience tracks very similarly to the average."
Among those who were eligible for the enhanced subsidies and then lost them, you find even starker cases, Norris said. She pointed to a hypothetical 63-year-old couple in West Virginia earning $85,000 — just above the subsidy threshold. In 2025, they could get the lowest-cost ACA Gold plan for $300 a month. In 2026, that same plan costs $4,562 a month.
Republicans have tried to repeal, gut, or otherwise undermine the ACA in one form or another since it passed in 2010, including through court challenges and funding fights. The law has always capped the percentage of income expected to be spent on premiums, with subsidies phasing out altogether above 400% of the federal poverty level. That was the baseline for years.
Mike Smith, president emeritus of The Brokerage Inc. and a health insurance expert, said the ACA increasingly resembles a two-tier system in which many middle-income Americans technically have insurance but cannot realistically afford to use it — "catastrophic coverage disguised as comprehensive insurance," as he described it.
"Having insurance doesn't always mean healthcare is affordable or accessible," Noonan said. When premiums rise to the point where people can no longer afford them, she said, the consequences can cascade quickly. People downgrade their coverage. Then they find themselves with less substantial insurance, paying more out of pocket since their plans cover less.
"The first impact is usually cost. Specialist visits, lab work, and routine screenings become harder to afford," Noonan said."What begins as a financial challenge can become a health crisis.
"A screening that gets skipped or a therapy that gets paused rarely stays contained to a single moment," Noonan added. "It resurfaces later as a preventable complication, a condition that has advanced further than it should have, or a recovery that is longer, harder, and more expensive."
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Among those who were eligible for the enhanced subsidies and then lost them, you find even starker cases, Norris said. She pointed to a hypothetical 63-year-old couple in West Virginia earning $85,000 — just above the subsidy threshold. In 2025, they could get the lowest-cost ACA Gold plan for $300 a month. In 2026, that same plan costs $4,562 a month.
Republicans have tried to repeal, gut, or otherwise undermine the ACA in one form or another since it passed in 2010, including through court challenges and funding fights. The law has always capped the percentage of income expected to be spent on premiums, with subsidies phasing out altogether above 400% of the federal poverty level. That was the baseline for years.
Mike Smith, president emeritus of The Brokerage Inc. and a health insurance expert, said the ACA increasingly resembles a two-tier system in which many middle-income Americans technically have insurance but cannot realistically afford to use it — "catastrophic coverage disguised as comprehensive insurance," as he described it.
"Having insurance doesn't always mean healthcare is affordable or accessible," Noonan said. When premiums rise to the point where people can no longer afford them, she said, the consequences can cascade quickly. People downgrade their coverage. Then they find themselves with less substantial insurance, paying more out of pocket since their plans cover less.
"The first impact is usually cost. Specialist visits, lab work, and routine screenings become harder to afford," Noonan said."What begins as a financial challenge can become a health crisis.
"A screening that gets skipped or a therapy that gets paused rarely stays contained to a single moment," Noonan added. "It resurfaces later as a preventable complication, a condition that has advanced further than it should have, or a recovery that is longer, harder, and more expensive."
The health insurance 'death spiral' hitting more and more Americans
The Affordable Care Act is facing what policy experts call its most serious affordability crisis since it began widely offering coverage more than a decade ago
