Health Insurance Cost Challenges Post-ACA Tax Credit Expiration
In recent years, Ross and Rebecca Tobiassen, small business owners in Sugar Grove, North Carolina, observed a consistent rise in their health insurance costs under the Affordable Care Act (ACA). Relying on the ACA for subsidized coverage since its 2014 inception, they found escalating premiums untenable. The monthly premium increase—from $130 to over $550—ultimately led them to cancel their policy, as Rebecca Tobiassen explained.
The Tobiassens, running a small auto repair shop, were among many Americans who terminated coverage after the expiration of enhanced tax credits at the end of 2025. These credits, enabled by the American Rescue Plan Act under the Biden administration, had previously reduced premiums and significantly increased ACA enrollments, doubling them to approximately 24 million.
The Centers for Medicare & Medicaid Services is expected to provide detailed data on current ACA enrollment soon. Preliminary analysis by KFF, based on Wakely Consulting Group research, predicts enrollment could drop from over 22 million at the end of 2025 to around 16.5 million by 2026. Notably, North Carolina saw a 22% decrease in individual ACA sign-ups, with over 213,000 people losing coverage—a more significant decline than any other state.
Rebecca Tobiassen voiced her frustration with the new costs, as their family continued to rely on Medicaid for their teenage daughters. She perceived the new pricing structure as indifferent to families like theirs. They chose to manage without insurance, making financial provisions for medical emergencies. Prior policies offered limited coverage for health issues, such as Ross's partially treated eye infection due to high medical costs.
Katie Alexander, from Pisgah Legal Services, noted a similar trend in western North Carolina, where clients opted out of ACA plans or selected less comprehensive ones due to rising costs. This trend included individuals without employer-based insurance or those ineligible for Medicaid.
Research analyzed by KFF indicates a steady increase in ACA premiums and deductibles since 2022, with a further spike for 2026 plans. This rising cost compelled families like the Tobiassens to switch from comprehensive silver plans to basic bronze options. Healthcare policy experts, like Risha Gidwani from the University of Colorado Anschutz School of Medicine, warned that the exit of healthier individuals from the insurance pool might escalate premiums for remaining enrollees, potentially leading to a "death spiral."
Despite these challenges, the Tobiassens have decided not to re-enter the ACA marketplace, exploring alternatives such as faith-based healthcare but ultimately choosing to forego formal insurance coverage. They have set aside funds for emergencies, but Rebecca acknowledged that, if necessary, their fallback options would include relying on credit or family support.