As the end of Affordable Care Act (ACA) subsidies draws near, millions of Americans are bracing for a potentially catastrophic financial blow. Without the subsidies, which provide billions of dollars in cost-sharing reductions to low- and moderate-income families, many will face astronomical health care costs starting next year.
For some, like freelance journalist Andy Lilienthal and his wife, the impact is already being felt. The couple's monthly premium for two people will increase from $660 to $1,700 in 2026, equivalent to their monthly mortgage payment in Portland, Oregon. "It's caused a great amount of uncertainty," Lilienthal said in an interview. "The stress levels have gone up significantly."
The anxiety is palpable among small business owners like Alaina Shearer, who estimates her family of four will pay an average of $400 a month for copays and prescriptions under their current plan. When the costs rise to nearly $1,300 more per month in 2026, the prospect of skipping medical treatment or going without health insurance becomes increasingly daunting.
"I have been exploring what it would be like if we just came in on a cash basis," Shearer said, her voice laced with concern. "But if an emergency happens, or one of us gets diagnosed with cancer or something, it's terrifying to think about what would happen."
The rising costs are not limited to individuals and small business owners; the country as a whole is grappling with the consequences of its unique healthcare system. The United States stands out among high-income countries for its lack of universal healthcare, and its spending habits reflect this.
"We're one of the few high-income countries that doesn't have universal health care," said Munira Z. Gunja, a senior researcher at the Commonwealth Fund. "The price of services in hospitals can be really, really high... For insurance companies, there's a whole spectrum of services where other people will profit, and the consumer may not see better health outcomes."
As the stakes grow higher, lawmakers are scrambling to find solutions. The government shutdown, which was triggered by debates over ACA subsidies, only added to the uncertainty. In the end, eight Democrats sided with Republicans, allowing President Donald Trump to sign a spending bill without the crucial health care measures.
For now, millions of Americans will face the consequences of this decision. As Deborah Kevin, a 62-year-old small business owner from Baltimore, Maryland, noted, "This increase makes us question what kind of care we'll actually be able to afford... Do we downgrade our coverage and risk higher out-of-pocket expenses if something goes wrong?"
As the clock ticks down to December 31, 2025, when ACA subsidies expire, Americans are bracing for a potentially disastrous financial blow. The anxiety is real, and the stakes have never been higher.
For some, like freelance journalist Andy Lilienthal and his wife, the impact is already being felt. The couple's monthly premium for two people will increase from $660 to $1,700 in 2026, equivalent to their monthly mortgage payment in Portland, Oregon. "It's caused a great amount of uncertainty," Lilienthal said in an interview. "The stress levels have gone up significantly."
The anxiety is palpable among small business owners like Alaina Shearer, who estimates her family of four will pay an average of $400 a month for copays and prescriptions under their current plan. When the costs rise to nearly $1,300 more per month in 2026, the prospect of skipping medical treatment or going without health insurance becomes increasingly daunting.
"I have been exploring what it would be like if we just came in on a cash basis," Shearer said, her voice laced with concern. "But if an emergency happens, or one of us gets diagnosed with cancer or something, it's terrifying to think about what would happen."
The rising costs are not limited to individuals and small business owners; the country as a whole is grappling with the consequences of its unique healthcare system. The United States stands out among high-income countries for its lack of universal healthcare, and its spending habits reflect this.
"We're one of the few high-income countries that doesn't have universal health care," said Munira Z. Gunja, a senior researcher at the Commonwealth Fund. "The price of services in hospitals can be really, really high... For insurance companies, there's a whole spectrum of services where other people will profit, and the consumer may not see better health outcomes."
As the stakes grow higher, lawmakers are scrambling to find solutions. The government shutdown, which was triggered by debates over ACA subsidies, only added to the uncertainty. In the end, eight Democrats sided with Republicans, allowing President Donald Trump to sign a spending bill without the crucial health care measures.
For now, millions of Americans will face the consequences of this decision. As Deborah Kevin, a 62-year-old small business owner from Baltimore, Maryland, noted, "This increase makes us question what kind of care we'll actually be able to afford... Do we downgrade our coverage and risk higher out-of-pocket expenses if something goes wrong?"
As the clock ticks down to December 31, 2025, when ACA subsidies expire, Americans are bracing for a potentially disastrous financial blow. The anxiety is real, and the stakes have never been higher.
. Like, I get that we need to make changes to our healthcare system, but $1,700 a month? That's crazy 
! And what really gets me is how some people are having to choose between paying their mortgage or going without health insurance 
. It's like, how do you prioritize your family's needs when it comes down to it? 
. I mean, we're one of the only high-income countries without it! The fact that insurance companies make so much money off of people who can't afford treatment is just not right 
.
Until then, I'll be keeping an eye on this situation and spreading awareness about how it affects everyday Americans 
I mean, come on... $1,700 a month?! 
How are people supposed to afford that? 
And what about those who can't even afford it? 
I remember when we had the ACA back in the day... 
It was like a safety net for everyone. Now, it's all falling apart... 
We need some kind of solution, pronto! 
What's next? 
Millions r going thru financial stress cuz of rising healthcare costs 
I'm getting really worried about this... If the ACA subsidies go away next year, millions of people are gonna be in serious trouble financially 
.
. It's crazy that we're one of the only high-income countries without universal healthcare 
. The cost is just too high, and it's not fair to people who can't afford it 
!