Many Americans Consider Forgoing Health Insurance as ACA Rates Surge Following Tax Credit Expiry
By Mary Cunningham
CBS News MoneyWatch
Updated January 9, 2026, 4:41 PM EST
As Affordable Care Act (ACA) premium rates soar in 2026, some Americans are making the difficult choice to go without health insurance altogether. The expiration of crucial federal tax subsidies on December 31, 2025, has caused premiums to spike dramatically, leaving many policyholders facing unaffordable out-of-pocket costs.
Personal Stories Highlight the Burden of Rising Costs
Kassidy Hooter, a 24-year-old mother of three from Shreveport, Louisiana, is among those hit hardest. In the final trimester of a high-risk pregnancy, Hooter was shocked to learn her insurance premiums had skyrocketed. With the lapse of ACA tax credits, her family would face thousands of dollars more in expenses. After weighing options, including giving birth at home to avoid medical debt, she ultimately chose to go without insurance during this critical time.
“I’m just hoping for the best,” Hooter told CBS News. Thanks to temporary financial aid from a local medical center covering three months, she plans to get her newborn enrolled in Medicaid—a government program for low-income families—to secure coverage postpartum. However, after aid runs out in late March, any medical costs will fall solely on her family.
Similarly, Stacy Kanas, a small business owner from Plantation, Florida, is reconsidering coverage for her and her husband. Their monthly premiums could rise to $2,500, more than double what they paid in 2025, despite already having a family history of serious medical needs. The prospect of being uninsured or underinsured amid such financial strain weighs heavily on her.
The Bigger Picture: ACA Tax Credit Expiration Impacts Millions
The ACA, implemented in 2010, dramatically reduced the uninsured rate in the U.S. from approximately 15% to 8%, according to Nima Sheth, vice president of health justice at the National Partnership for Women and Families. However, experts warn that without legislative intervention, the number of uninsured Americans is poised to jump in coming years.
The Congressional Budget Office estimated in 2024 that the end of tax credits will lead to an average increase of 3.8 million uninsured people annually from 2026 through 2034. This surge is partly because premiums for those relying on subsidies could more than double—rising by an average of 114%, according to nonprofit health policy group KFF.
Michelle Sternthal, interim senior director of policy and strategy at health care advocacy group Community Catalyst, describes the situation bluntly: “What we’re seeing here is a policy choice—turning insurance into a luxury item and medical debt into the default.”
Legislative Efforts to Extend ACA Tax Credits and Ongoing Challenges
In response to this growing crisis, the House of Representatives recently approved a three-year extension of the expired ACA tax credits. However, the proposal faces uncertain prospects in the Republican-controlled Senate. Lawmakers from both parties view the bill as a potential starting point for negotiations to preserve some measure of financial assistance.
Despite these efforts, some individuals are already adjusting coverage choices to manage costs. Robert Myers from outside St. Louis downgraded his plan from silver to bronze, reducing monthly premiums from $400 to zero but accepting a high $8,000 deductible and costly co-pays. This trade-off means he plans to reduce routine doctor visits and could delay care until emergencies arise.
Experts warn such cost-avoidance behaviors ultimately lead to worse health outcomes and higher expenses. “They’ll go to the ER to get what they need fixed with a band aid, and then not get long-term care,” Sheth said. This pattern can increase uncompensated care costs for hospitals, potentially driving up prices for all patients.
Sternthal emphasizes the broader impacts: “Every delay locks families into decisions that harm their health and financial stability and reverberates through local communities and businesses.”
What Enrollment Periods and Options Look Like Now
Americans still have a limited window to enroll in ACA marketplace plans in most states through January 15, though the lapse in tax credits makes coverage prohibitively expensive for many. Meanwhile, some states have opted to continue subsidies independently to ease the transition.
Those unable to afford coverage face difficult decisions amid an uncertain political and economic landscape. Advocates urge Congress to act swiftly to prevent millions from losing access to affordable health care.
For those interested in following ongoing developments, CBS News will continue to report on efforts to extend ACA benefits and the impact on American families.
This article was edited by Alain Sherter and originally published by CBS News.