Andy Lilienthal, a 47-year-old freelance journalist and marketer, is one of millions who will be affected by the end of Affordable Care Acts subsidies. He and his wife, as small business owners, currently pay about $660 a month for health insurance through the ACA marketplace for two people with the help of ACA subsidies. But without the subsidies, they are looking at paying about $1,700 a month in 2026, which will cost more than their monthly mortgage in Portland, Oregon.
“It’s caused a great amount of uncertainty,” Lilienthal told Salon in a phone interview. “It has definitely upped the anxiety levels around here, the stress levels … It’s been a real burden on pretty much everything right now.”
During the 43-day long government shutdown, Democrats kept pushing to include an extension of the Obamacare subsidies in a spending package to reopen the government. However, eight Democrats sided with Republicans to end the record-breaking shutdown. President Donald Trump signed the spending bill into law without the health care measures, leaving potentially millions to go without health care in 2026 or face astronomical costs. An estimated 24.3 million Americans are insured through ACA plans and an estimated 92 percent receive some form of subsidy, according to the Centers for Medicare & Medicaid Services. The ACA subsidies will end in December. 31, 2025, though some lawmakers are looking for solutions.
Lilienthal isn’t alone in his anxiety, and it’s not just the loss of ACA subsidies if nothing changes. This week, a new West Health-Gallup study found that Americans are going into 2026 more anxious about health care costs than in previous years. The survey, which has been conducted annually since 2021, was based on roughly 20,000 people across the country who were surveyed between June and August of this year, before the government shutdown. They were asked 27 questions about their health care experiences. Almost 50 percent of adults surveyed said they were worried they wouldn’t be able to afford health care in 2026. In the survey, one in five adults said that someone in their household was unable to afford a prescription in the past three months. An estimated 30 percent of those surveyed said a household member had skipped medical treatment due to cost being a barrier.
Alaina Shearer, an owner of a boutique ad agency called Good Now, told Salon while she won’t be directly affected by ACA subsidies as she doesn’t receive them, but she is considering going without health care for the first time in her adult life. Currently, the plan she is on for a family of four will increase from $1,295 a month to $1,695 in 2026 — but the coverage they have is not great. In fact, the deductible is $20,000, which means they have to pay for prescriptions and every medical screening. She estimages that they pay an average of $400 a month for copays and prescriptions. The “better” plan she is considering for next year, with a $7,000 deductible, is $2,300 each month.
“It’s hard not to think of myself as failing my family and my kids.”
“I have been exploring, asking my local son’s doctor, like, what would it be if we just come in on a cash basis?” she said. “But if an emergency happens, or one of us gets diagnosed with cancer or something, it’s terrifying to think about what would happen.”
Shearer has owned her business since 2009. Back then, she paid $350 for her family’s health insurance.
“It’s hard not to think of myself as failing my family and my kids,” Shearer said. “We’ve never gone without health insurance, the thought of that alone just makes me feel like I’m failing my family somehow — but then I remind myself, this is bigger than us.”
The United States is the only high-income country that doesn’t have universal health care. While high-income countries tend to spend more per person on health care than lower-income countries, the U.S. spends far more per person on health. And yet, it has the lowest life expectancy among large, wealthy countries.
Munira Z. Gunja, a senior researcher in the Commonwealth Fund’s Promoting International Learning and Exchange program, told Salon in a phone interview that health care is so expensive in the United States for a variety of reasons.
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“The price of services in hospitals can be really, really high,” she said. “For insurance companies, there’s a whole spectrum of services where other people will profit, and the consumer may not see better health outcomes.”
In 2023, an estimated 8 percent of Americans lacked health insurance. Deborah Kevin, a 62-year-old based in Baltimore, Maryland, and a small business owner of Highlander Press, told Salon that going without health care at her age isn’t really optional — but she’s not sure how she’s going to afford next year’s increase. Currently, she pays $365 per month for health insurance through Blue Cross/Blue Shield for her and her husband. It comes with a $6,100 annual deductible. Without ACA subsidies, her premium will jump to nearly $1,600 a month in 2026.
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“This increase makes us question what kind of care we’ll actually be able to afford,” Kevin said. “Do we downgrade our coverage and risk higher out-of-pocket expenses if something goes wrong? Do we absorb the cost and slash other areas of our budget?”
Figuring out how to absorb these costs has led to “more than a few sleepless nights,” she said.
“There’s a quiet kind of stress that comes with running your own company: you carry the weight, alone, of every decision — how to care for your clients, your team, your family and yourself,” Kevin said. “This health insurance increase makes that weight even heavier.”
