Americans opt out of health insurance as ACA costs rise

When Kassidy Hooter discovered in December how much her health insurance costs would increase this year, she was overwhelmed with anxiety. The Shreveport, Louisiana, mother of three knew she needed medical care — she was in the final trimester of a high-risk pregnancy. However, the family could no longer afford their Affordable Care Act (ACA) plan because a federal tax subsidy was set to expire on December 31, 2025, which would mean thousands of dollars in additional out-of-pocket expenses.

“We seriously considered just giving birth at home,” Hooter, 24, told CBS News. “It’s an insane amount of debt to take on.”

In the end, Hooter decided to forgo insurance altogether. A local medical center offered her three months of financial aid that will cover her until her due date in February and into late March. After that, she will have to bear any medical expenses on her own. Her plan now is to get her newborn on Medicaid, a government health plan for low-income Americans, as quickly as possible.

“I’m just hoping for the best,” she said.

Health Insurance as "Luxury"

Since its introduction in 2010, the ACA has played a significant role in reducing the number of uninsured Americans from approximately 15% to 8%, according to Nima Sheth, vice president of health justice at the National Partnership for Women and Families, a nonprofit advocacy group.

However, experts warn that the number of people without health insurance could surge if Congress fails to address the issue for the 22 million Americans who received an ACA tax credit. The nonpartisan Congressional Budget Office (CBO) estimates that millions of people will lose coverage unless these subsidies are extended.

Americans in most states have until January 15 to enroll in an ACA marketplace plan, according to healthinsurance.org. Without the tax credits, premiums for ACA enrollees who previously relied on the subsidies will increase by an average of 114%, according to KFF, a nonprofit provider of health policy news and research.

“What we’re seeing here is a policy choice — turning insurance into a luxury item and medical debt into the default,” Michelle Sternthal, interim senior director of policy and strategy at health care advocacy group Community Catalyst, told CBS News.

The House of Representatives approved a three-year extension of the expired ACA tax credits. While the legislation faces challenges in the Republican-led Senate, lawmakers believe it could serve as a starting point for a compromise that would keep the credits alive in some form.

The CBO estimates that the House bill would increase the deficit by around $81 billion from 2026 to 2035. At the same time, the measure would boost the number of people with health insurance, a CBO spokesperson told CBS News.

Personal Financial Struggles

Plantation, Florida, resident Stacy Kanas, whose family also received an ACA tax credit, is now considering going without health insurance after realizing that her monthly premium to cover her and her husband would rise to $2,500 — more than double what she was paying last year to cover both of them plus her 20-year-old daughter.

“It’s weighing extraordinarily heavily on me,” Kanas, 59, told CBS News. “My husband had a major surgery about five years ago, and we don’t want to be uninsured.”

Although in decent health, the small business owner worries about what could happen if someone in her family falls seriously ill. “You’re one catastrophic event away from perhaps having a financial disaster,” she said.

Even people who keep their ACA coverage could end up skipping out on care to avoid out-of-pocket expenses, experts said.

“If you’re underinsured and you have high deductibles, the coverage that you’re getting is designed to dissuade getting care, including preventative care, so you’re going to delay your care until there are emergencies,” Sternthal said.

Impact on Healthcare Access

Robert Myers, a consultant based outside of St. Louis, Missouri, was on a silver ACA plan last year but switched to a bronze plan after learning his premiums would rise to $400 a month, up from $17 in 2025.

Under his new plan, the 31-year-old does not have a monthly premium. However, Myers could owe much more in out-of-pocket costs due to $80 co-pays and an $8,000 deductible. As a result, he's planning on scaling back on doctor's visits, a trend experts say ends up driving more people to the emergency room for care.

“They’ll kind of go to the ER and get what they need fixed with a band aid, and then not get long-term care,” Sheth said.

This can have wider ripple effects because an increase in uncompensated hospital care can drive up costs for other patients, as facilities seek to recoup the costs, according to Sternthal, who supports an extension of the ACA tax credits.

“Every delay locks families into decisions that harm their health and their financial stability, but then also reverberates out into the business community, the local community,” she said.