The sales pitch for the Affordable Care Act was always simple: a marketplace where regular people could buy real coverage. The new reality, according to families now staring at four-figure monthly bills, is simpler still. Pay up, pare back, or roll the dice.
The tension sits right in the policy plumbing. Enhanced federal subsidies helped hold down premiums for years. Now, as those extra credits fade for many enrollees, the bill is landing on kitchen tables, not in congressional hearing rooms.
CBS News, citing reporting produced with KFF Health News, described people across multiple states making the kind of choices politicians love to talk around: dropping coverage entirely, keeping insurance only for a child, or switching to plans with deductibles that can swallow a year.
A Premium Spike That Turns Coverage Into a Bet
Nicole Wipp, a 54-year-old self-employed lawyer in Aiken, South Carolina, told CBS News that her family looked at ACA options and made a decision that sounded less like health planning and more like risk management.
“We decided that, ultimately, it would be better for us to gamble.”
In her case, the math was brutal. A bare-bones bronze family plan was quoted at $1,400 a month, up from $900 the year before, and still came with a deductible of more than $10,000, according to the report. The family chose to insure only their 15-year-old son for around $200 a month and leave the adults uninsured.
The Self-Employed Squeeze Gets a New Price Tag
These stories share a theme that is politically inconvenient: the people getting hit are not necessarily the poorest Americans, and they are not covered by Medicaid.
Noah Hulsman, a 37-year-old skate shop owner in Louisville, Kentucky, told CBS News he lost eligibility for federal help with his gold plan and moved to thinner coverage. The catch is the deductible, which the report said is about a quarter of his annual income.
That is not a theoretical policy debate in a town hall. It is inventory, rent, payroll, and one bad fall.
“I’m just riding the line right now,” Hulsman said. “One slip and it’s gonna be uncomfortable.”
The power dynamic is familiar. When premiums and out-of-pocket costs spike, families absorb the shock first. Providers get stuck chasing payments later. Insurers rewrite pricing models. Washington argues about the process.
Rationing Medication, Hunting for a Job With Benefits
Loretta Forbes, 56, living outside Nashville, Tennessee, told CBS News that her monthly marketplace premium jumped from $250 to $2,500 after enhanced subsidies expired. She said she started rationing medication for rheumatoid arthritis. Her husband, Jim, 59, gave up a handyman business and began looking for a job that came with insurance.
Forbes, who was diagnosed with cervical cancer in 2021, described the moment they realized their plan was no longer realistic.
“We were like: ‘OK, we can’t breathe. We’re gonna tap out,'” Forbes said.
Their story also shows how thin the margin can be between coverage and no coverage. According to CBS News, a job offer with benefits arrived just before the couple’s marketplace coverage lapsed. Forbes later learned she was approved for Medicare because of disability, with a $155 monthly premium automatically deducted from her disability check.
“You cannot imagine what a relief it is to know I will have care,” Forbes said.
Washington Talks Affordability While the Bill Moves
The political fight is not subtle. Cheryl Fish-Parcham, director of private coverage at Families USA, told CBS News that premiums are becoming unaffordable while other costs rise, and she pointed directly to Congress.
“Premiums are getting quite unaffordable for a lot of people. The cost of both health care and other basic needs is rising,” Fish-Parcham said. “This is an especially critical time for Congress to do something.”
The report also cited a January poll from KFF finding that more than 80% of Americans said their cost of living rose in the past year, and that health care costs topped the list of worries, with about two-thirds saying they were concerned about affording health care.
Republican lawmakers, CBS News reported, have largely refused to renew enhanced subsidies, backing alternatives such as expanded health savings accounts and more lower-premium plans that typically carry higher deductibles and copays. Those proposals can shrink a monthly payment while leaving families exposed when something actually happens.
Meanwhile, CBS News reported that President Donald Trump released an outline of a health plan in January with few details on lowering out-of-pocket costs, and that the One Big Beautiful Bill Act he signed in July is expected to leave millions uninsured over the next decade by reducing federal health spending by nearly $1 trillion, mostly from Medicaid.
The contradiction is the part voters tend to notice: politicians promise relief from high costs while the system pushes more risk onto patients, particularly those who are self-employed or hovering above Medicaid eligibility.
Insurers Are Already Pricing in the Dropouts
One reason this story matters beyond individual hardship is that insurance markets do not just react. They anticipate.
CBS News reported that about 1.2 million fewer people signed up for ACA plans for the current year, citing federal data, and that analysts expect more people to stop paying premiums and drop coverage. It also reported that marketplace insurers said they are charging 4 percentage points more in 2026 because they expect healthier people to exit when enhanced credits expire, leaving a costlier pool behind.
That is the market version of a warning flare. If the people most likely to need care stay, and the people least likely to need care leave, premiums tend to climb. Then more people leave. Then premiums climb again.
Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University, called the trade-offs “untenable” in comments cited by CBS News.
“People are faced with absorbing this huge financial and health risk,” she said.
What To Watch Next
The immediate question is not whether families will complain. It is what happens when they act.
Watch for three pressure points.
- Midyear coverage losses: People who sign up and then stop paying premiums can quietly swell the ranks of the uninsured, especially if budgets tighten.
- More selective coverage: Families insuring only a child, or only the healthiest adult, is a rational household move that can scramble risk pools.
- Political accountability: Enhanced subsidies were never just a health policy. They were a cost-of-living policy. The party that owns the lapse will be arguing about it in every competitive district.
There is a version of this story where Congress restores help, insurers revise rates, and families climb back into coverage. There is also a version where the marketplace becomes a high-deductible holding pen for people who cannot get insurance at work, but cannot afford to buy it on their own.
The people in this report already picked their version. They just did it without a vote.
