Health care affordability crisis worsens as premiums spike

ACA subsidies – A Utah couple’s Affordable Care Act coverage went from about $500 a month in 2025 to more than $2,100 after enhanced subsidies expired. Their experience mirrors new polling showing fewer than half of U.S. adults feel confident they can afford health care, whil

On a recent morning, Stacy Cox sat with her husband, John Crowley, and replayed the same question: how much pain does the system have to cause before it starts to make sense for ordinary families.

Cox, 49, and Crowley, 55, are both self-employed and don’t receive employer health insurance. Under the enhanced Affordable Care Act subsidies, their monthly premium was about $500 in 2025. Then Congress failed to extend those subsidies last year. and their bill jumped to more than $2. 100 a month—an increase that Cox described as impossible to absorb.

“It was too much,” Cox said. “We’re caught in the middle. We make too much money to qualify for any additional assistance. But we don’t make enough money to afford a $2,100 per month premium.”

The affordability squeeze facing Cox and Crowley is showing up in national data. In a West Health-Gallup affordability index published on June 18. fewer than half of adults said they believed they could pay for health care. medical appointments. and prescriptions. Another 41% of Americans were “cost insecure. ” either because they lacked access to affordable care or couldn’t pay for care or medicine. based on a survey of 5. 660 adults aged 18 and older.

For Cox, the numbers turned into real trade-offs. To make their insurance workable after the subsidy change, she and Crowley searched for alternatives and ended up on a short-term insurance plan that costs $565 per month.

Short-term plans typically charge lower premiums, but the coverage can be thinner—and often comes with fewer consumer protections. Cox and Crowley’s plan did not cover existing medical conditions or preventive care. It also came with a $10,000 deductible, the amount they must pay before coverage kicks in.

They said they’re healthy adults, but they’ve been skimping on care and recommended medical tests because they can’t afford provider prices. Cox said they’re keeping the short-term plan mainly as protection against a medical emergency.

Crowley’s health scare put that tension into stark relief. He developed leg pain and numbness and, Cox said, delayed going to the doctor until the pain became too much. He then needed an MRI.

An imaging center affiliated with a local health system told them the MRI would cost $2. 200 with insurance or $1. 600 if they paid cash without using insurance. Either way, Cox said, they would have to pay the full price because their short-term plan includes the $10,000 deductible. When they chose the less expensive $1. 600 cash option. they were told that amount would not be applied toward their insurance deductible.

Cox said the situation left her “irate,” especially because the imaging center offered a discount of $600 if they didn’t submit paperwork to the insurance plan.

“It felt like extortion,” Cox said. “You’re going to take us for an extra $600 just so we could put that toward our deductible?”

After searching further, Cox and Crowley found another imaging center in St. George, Utah, that would complete the MRI for $399. The couple said the lower price made it worth taking a 90-minute drive to and from the center.

Even with the MRI handled, the costs tied to their bare-bones insurance plan have been squeezing their household finances. Cox said they’ve cut back on vacations, dining out, and streaming services.

They’ve both built successful businesses they love—Cox works as a photographer, and Crowley is an audio engineer. But she said they are now considering taking corporate jobs just to get employer-provided health insurance.

“We have a very good life. We make enough to pay for our mortgage, our cars, our car insurance,” Cox said. “Every month, we come back to the table to say, ‘Have we reached the pain point yet?’ It’s all because of health care.”

The affordability crisis isn’t confined to premiums. As insurers and employers deal with rising costs, higher prescription drug prices, medical tests, and hospital bills can also push families into financial distress.

The Centers for Medicare & Medicaid Services reported on Jan. 28 that about 23 million Americans signed up for ACA coverage in 2026, down from 24.2 million signups as of January 2025. CMS said the number of people who dropped ACA coverage won’t be known until more robust enrollment figures are reported later this year.

Employers who offer insurance to most working-age Americans are also facing escalating costs. Companies expect to spend an average of $18,500 per employee for health insurance in 2026, an increase of 6.7% from a year ago, according to the consultant Mercer.

Howard Forman. a Yale School of Management professor and a physician. argued that the problem isn’t driven by a single bad decision. “This is not about any one bad actor,” Forman said. “This is about a system that ultimately leads us to spend more and more over time. We have not had the type of reckoning in this country that we need to have.”.

Affordable Care Act ACA subsidies health insurance premiums West Health-Gallup affordability index short-term health insurance MRI costs medical affordability U.S. health care costs Mercer health insurance estimates Medicaid and Medicare enrollment