Ginny Murray says she and her husband, Chaz, are out of options for health insurance. In January, their premiums are expected to rise higher than they’ve ever gone up before, putting the cost out of reach.
The Arkansas couple plan to drop their coverage, betting their savings will be enough if unexpected illness strikes.
“Our plan is to keep putting the money we’re already paying towards health care in savings,” said Murray, whose insurance is covered through the Affordable Care Act, “and really just hoping that we don’t have a stroke or we don’t have a heart attack.”
They’re part of a broader shift taking shape as enhanced subsidies for ACA premiums are set to expire at the end of the year. Without them, many Americans could see their monthly premiums double or even triple next year, a spike that’s forcing people to rethink what they can afford — or whether health insurance is even worth it.
Next year will be the biggest premium increase since the ACA took effect, said Art Caplan, the head of the medical ethics division at NYU Grossman School of Medicine in New York City.
Open enrollment for ACA plans begins next month, and there is no data yet on how many people plan on dropping their coverage. However, the Congressional Budget Office projects nearly 4 million will drop their health insurance for next year if the subsidies expire. The issue has paralyzed Washington, where Democrats say they won’t vote to reopen the government unless the tax credits are extended.
For Murray, 48, the math simply doesn’t work. A truck driver, she was injured in a work accident 2 ½ years ago and is still receiving workers’ compensation, unable to work full time. Her husband, also a truck driver, continues to drive as an independent owner-operator.
The couple’s monthly premium is around $1,500; with the subsidies, it comes down to around $450. But the state regulators approved a 26% rate increase for their insurer, which means their premiums will rise by at least $400 next year. The cost could more than triple if the subsidies expire.
“What other choice do we have?” Murray said.
‘A catastrophic event’
Choosing to go uninsured isn’t new. Before the ACA became law in 2010, millions of Americans made similar choices — often with devastating financial consequences, said Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School.
From 2010 to 2023, the rate of people going uninsured fell from around 16% — about 48 million people — to 7.7%, according to data from the Center on Budget and Policy Priorities, a nonpartisan research group. Meanwhile, enrollment in ACA plans has grown from 8 million people in 2014 to a record 24.3 million people in 2025, thanks in part to the enhanced subsidies, according to the health policy research group KFF.
“Unless you are extraordinarily rich, it is effectively not possible to save enough money to cover the costs of a serious illness or major trauma,” Gaffney said. “For the uninsured, medical debt and bankruptcy is just one major illness or injury away.”
That reality is compounded by the fact that many Americans don’t have much of a financial cushion, said JoAnn Volk, co-director of Georgetown University’s Center on Health Insurance Reforms.
In 2024, roughly 37% of adults said they would struggle to cover a $400 emergency expense, according to the Federal Reserve.
And for those who do manage to build a large emergency fund, the balance often pales in comparison to what a common medical procedure could cost, Volk said.
“I’m sure people plan to save the money,” Volk said, “but [I’m] not sure how many can do so, and I expect they don’t know how much they’ll need for some common procedures if they have to pay out of pocket, let alone a catastrophic event or unexpected diagnosis.”
‘It’s only gotten worse’
D’nelle Dowis, of Denver, knows how quickly an unexpected medical expense can add up. She recalls how her father’s appendectomy in the 1990s was a huge financial burden for her family.
“It was a big thing for our family having to deal with that,” Dowis said. “So, there’s some kind of childhood fears wrapped up in this.”
Still, Dowis and her husband, Christopher, plan to drop their ACA coverage for next year and put that money into a high-yield savings account.
The Denver couple, both in their 40s, run a web development business together — which Dowis says they were only able to start due to the safety net the ACA provided. They pay about $600 a month in premiums, but that could jump to $1,300 next year.
Keeping their coverage would mean cutting back on care for their two aging dogs, both of whom have cancer, as well as putting less money toward their retirement savings and holiday travel to visit family.
“We’d be cutting down on other things that I see as necessities, and I’m not sure if, at this point in my 40s, I’m necessarily willing to do that or not,” Dowis said.
Both she and her husband are healthy, which makes going without coverage feel manageable for now.
“I am exceptionally frustrated and there’s a level of anger to it,” Dowis said. “We’ve had 15 years now to try to solve this problem, and it’s only gotten worse.”
Claire Esparros, 34, said she has the same “psychological, mental, emotional breakdown” every year when it’s time to renew her ACA coverage and face the new monthly rate.
Esparros, a New York City-based freelance photographer, has no major health problems and mostly uses her coverage for the basics — annual physicals and the occasional sick visit. But she said her plan hasn’t offered much peace of mind.
“It’s horrible insurance,” she said. She has a so-called catastrophic plan, which carries a deductible of nearly $10,000. “The only reason I have it is if something truly horrible happens.”
Next year, though, she’s planning to let it go. Her monthly premium is set to triple from about $300 to $900 — and she said she can no longer justify the cost.
Instead of setting up a savings account like the Murrays and Dowises, Esparros is exploring health care co-ops, which pool money among members to cover medical expenses.
Caplan, of NYU Grossman School of Medicine, said co-ops, sometimes called community-based self-insurance, can be cheaper and more flexible — especially for healthy people — but they aren’t regulated under the ACA. That means they may not cover certain medical bills and are subject to bankruptcy from a single expensive case.
“It is a ‘Put your faith in your neighbor’ idea,” he said.
Esparros has been looking into two options and said so far she hasn’t heard of any major drawbacks. “It feels more personal and safe,” she said.