Impact of ACA Premium Hikes on Families in North Carolina
Since its inception in 2014, Ross and Rebecca Tobiassen have relied on the Affordable Care Act (ACA) for health insurance, supported by federal tax credits. Recently, they opted out of their policy due to a substantial hike in premiums, which surged from $130 to over $550.
The Tobiassens, who run a small automotive repair shop near Appalachian State University in North Carolina, face significant workplace risks. This is especially true for Ross, who has experienced accidents resulting in severe eye injuries, highlighting the importance of comprehensive healthcare coverage.
The expiration of enhanced tax credits, introduced by the American Rescue Plan Act during the COVID-19 pandemic, has significantly raised healthcare costs. These augmented subsidies enabled higher ACA enrollment and reduced premiums, but their cessation is prompting a decline in marketplace participation. Wakely Consulting Group projects a drop from over 22 million enrollees in late 2025 to about 16.5 million in 2026.
Impact on North Carolina and Broader Concerns
North Carolina especially shows a steep 22% fall in ACA enrolments for 2026, the sharpest nationwide. Although their daughters remain covered by Medicaid, the Tobiassens feel federal insurance policies inadequately support their family’s needs. Their experience underscores the tough choices many ACA users face between costs and coverage benefits.
Katie Alexander, leading volunteer efforts at Pisgah Legal Services, reports a trend of ACA clients abandoning their coverage or opting for less comprehensive plans. These include individuals in flexible jobs or starting businesses, who often lack access to employer-provided insurance or Medicaid eligibility.
KFF data indicates both premiums and deductibles for ACA plans have consistently risen, hitting a notable peak during the 2026 enrollment period. Rebecca Tobiassen reflects critically on their decision, recalling the more affordable $30 monthly premium they paid initially.
Research by Risha Gidwani from the University of Colorado Anschutz School of Medicine suggests that without subsidies, many ACA plans become financially unviable for average consumers. Gidwani warns of a potential 'death spiral' in the insurance risk pool as healthier individuals exit, causing rising premiums for those remaining.
Considering Alternatives Post-ACA
After dropping ACA coverage, the Tobiassens explored alternatives like faith-based healthcare. Ultimately, they chose to remain uninsured, instead reserving funds for emergencies and planning financial contingencies with family support and credit access.