Michigan nurse goes without health insurance as ACA costs double for 2026

For Stacey Hilton, a 55-year-old registered nurse from West Michigan, 2026 will be the first year without health insurance. This difficult decision stems from a significant increase in health care premiums, a reality shared by many Americans as pandemic-era financial assistance expires.

The Changing Landscape of Health Insurance

Hilton, who manages high blood pressure and fibromyalgia, is bracing for the uncertainties ahead. She is proactively focusing on her health through lifestyle changes, including improved sleep, diet, and exercise, hoping to avoid a health crisis. In 2025, she was one of over 24 million Americans utilizing the Affordable Care Act (ACA) marketplace.

The ACA marketplace primarily serves individuals who are self-employed, work part-time, are students, are early retirees, or are unemployed. Tax credits are available to those with household incomes between 100% and 400% of the federal poverty line – $15,960 for a single individual and $33,000 for a family of four in 2026.

Did You Know? The ACA successfully reduced the uninsured rate for those under 65, decreasing from 17.8% in 2010 to between 9.5% and 10.9% in the following decade.

The Impact of Expiring Subsidies

The expiration of extended tax credits from 2021 on December 31, 2025, has led to a sharp increase in out-of-pocket costs for many. Despite consideration by federal lawmakers to extend these subsidies or find alternative savings, an agreement wasn’t reached. The Kaiser Family Foundation (KFF) estimated an average premium increase of approximately 114% in 2026. Hilton experienced a doubling of her monthly bill, reaching around $800.

This trend is reflected in nationwide enrollment figures. As of late January, Michigan saw a decrease of roughly 34,000 enrollees, totaling 497,064. Nationally, sign-ups were down by over 1 million, reaching the lowest point since 2020. A January KFF poll revealed that two-thirds of Americans are worried about affording health care, exceeding concerns about affording basic necessities like food, housing, and utilities.

Expert Insight: The increase in uninsured individuals and the rising cost of coverage highlight a persistent challenge within the ACA – affordability. While the law expanded access, it hasn’t fully addressed the financial burden for many Americans.

Navigating a More Expensive System

Kendra Bonga, a self-employed upholsterer from Grand Rapids, found a plan she could afford for 2026, but it came with trade-offs. Her monthly premium increased from $180 to $585, the deductible doubled, and her preferred therapists were no longer covered, even with income-based subsidies. She ultimately chose a plan with a lower monthly payment but a significantly higher deductible, hoping her existing providers would remain in-network.

Dr. Mark Fendrick, a University of Michigan physician and professor involved in the ACA’s development, noted that while the ACA expanded insurance coverage, many remained “underinsured.” He expressed concern over the return to a situation resembling pre-ACA times, where individuals routinely went without health insurance.

What Options Exist for Those Who Can’t Afford Insurance?

For those unable to afford a plan, resources are available. Michigan’s major health systems offer programs for individuals in financial need. Patients are encouraged to discuss financial limitations with their healthcare providers, who may suggest lower-cost tests or generic medications. Michigan provides a website to connect low-income families with free or low-cost care. Local health departments offer free vaccinations and testing, and organizations like the Patient Assistance Network and GoodRx provide financial assistance and prescription drug discounts.

Looking Ahead

The rising cost of health care extends beyond the ACA marketplace. Even individuals with employer-sponsored insurance, like Randi Boyd, are experiencing substantial premium increases. A fundamental shift in the healthcare system, moving away from a “fee for service” model to a value-based system prioritizing outcomes, may be necessary.

Frequently Asked Questions

What caused the increase in ACA premiums for 2026?

The expiration of enhanced premium tax credits that were in place during the COVID-19 pandemic caused the increase in ACA premiums for 2026.

What is the federal poverty line for 2026?

The federal poverty line for 2026 is $15,960 for a family of one and $33,000 for a family of four.

What options are available for people who can’t afford health insurance?

Options include programs offered by Michigan’s major health systems, community health centers with sliding fee scales, free services offered by local health departments, and assistance from organizations like the Patient Assistance Network and GoodRx.

As healthcare costs continue to rise, what role should individual responsibility, employer contributions, and government policy play in ensuring access to affordable care?