Early state data reflects signs of financial strain for people who can’t afford to pay hundreds of dollars more in monthly premiums once enhanced federal subsidies expire at the end of the year.
I’m co-opting your comment, so apologies if you don’t approve.
It’s a bit of both, opting and forced. At this point, I’ve commented in dozens of threads about my personal situation, so apologies to those folks who are seeing yet another comment with the same sentiment from me.
In a nutshell, I was laid off this year due to the Trump administration, due to a variety of factors I have not returned to work, and I’m using the ACA for health insurance. While I still have several days to make a final decision, I can see an argument for classifying my situation as “opting for no coverage” versus being forced.
Here’s the thing, in my entire adult life, health insurance has always cost me more than it saved me. Literally, 2025 is the very first year where I might have broken even, and that was only because I had an unexpected health emergency.
On top of that, when you’re unemployed and in a financially strained situation, being 1 million dollars in debt is pretty much the same as being 10 thousand dollars in debt. Can’t repay either. So, having health insurance with a maximum out of pocket is still no guarantee that I won’t end up in financial ruin.
More importantly, the degree to which health care costs are going up this year is unprecedented for a lot of people. The raw, unsubsidized cost of ACA plans is increasing close to 50%. Bronze plans (lowest) cost as much as silver plans did for 2025, silver plans cost as much as gold plans. In addition, all the out of pocket expenditures are increasing like copays, coinsurance, deductibles, and maximum out of pocket. But that’s not all, the cost of prescriptions and medical costs in general are increasing due to inflation, so even if the insurance is 100% comparable to last year, we’re still paying much more. The final and often the most significant blow is that these tax credits / incentives are going away. These were significant, they made the lower tier plans free for those most in need and provided significant relief for people earning up to around $60,000. All combined, the cost increases associated with these plans is honestly absurd. Truly a WHAT THE FUCK situation.
Even if we all agreed that this is how it needs to be, no sensible and reasonable policy would let this all happen at once. At a minimum, these increases and changes should have been phased in slowly enough to allow people to adapt and there should have been much more communication that this was on the horizon. I say that, because after I was laid off this year, I was directed towards an ACA plan (versus COBRA coverage, if you don’t know what that is, just know that it’s expensive and limited) with no mention of this time bomb about to explode. That’s a major failure on all fronts.
So, apologies continue, this ended up being yet another novel on the subject. But it’s important that people know how terrible and complicated this situation is.
In summary (i.e. the TLDR) is that I could probably afford the very cheapest and shittiest plans offered through the ACA for 2026, but at the end of the day I have to look at the risk versus the cost, and realistically, the case could be made that if I choose not to get a plan, I’d be opting for no coverage versus being forced. Not that my situation is the norm, but I’m also sure I’m not the only person in the USA in this kind of predicament.
I noticed you mentioned that insurance has always “cost me more than it saved me”. I feel like this is a fundamental issue in how Americans think about health insurance.
Insurance should cost you more than you get out, if everyone got more than they put in it would be insolvent. However, Healthcare in the US has become so broken that insurance=access to many.
We shouldn’t need insurance to access our primary care doctors or basic treatment, but for some reason it’s designed around this complicated opaque system.
I noticed you mentioned that insurance has always “cost me more than it saved me”. I feel like this is a fundamental issue in how Americans think about health insurance.
I’m sure many Americans do look at health insurance in that one singular way, no different than how some people are single issue voters. However, taking that phrase out of the context I presented it misses out on the statement I was making.
For people in my situation, we’re fully aware that insurance of all types generally costs more than you get out. And I think most Americans understand that fundamentally, at least to some degree, but that’s not super relevant one way or the other.
Either way, the point I was making is that not everyone is being forced out of coverage, many of us are opting out or at least considering it.
We do have to look at it from the lens of cost versus value. It’s not that I can’t afford to go to the doctor and buy my healthcare supplies without insurance, it’s that I might not be able to afford to those things if I’m also paying for insurance. Basically, it has to save me more than it costs in my situation. But the other aspect of this decision that gets lost if you only focus on the “cost me more than it saved me” is that the plan would need to offer meaningful financial protection against disaster (i.e. the traditional role of insurance), but with maximum out of pocket amounts being so high, there’s little to no value there. Which means the affordability part (i.e. costs more than it saves) becomes a much more important aspect to consider.
Sure, insurance mathematically needs to be a losing deal for most people. Except health insurance in the US costs like $10k-$20k per year more than what you get out (if you’re healthy), even the cheap plans. Not exactly an easy pill to swallow, especially if you’re average or below income. We mask the cost by having employers pay for most of it if you’re employed and get benefits, but that cost is included in your total compensation package and effectively coming out of your wages even if your paystub pretends it isn’t.
its also extremely convoluted too. A private physician will probably need to hire tech to deal with the insurance, and then you have to worry about what is covered and you must call the insurance companies to verify coverage, its all messy.
we spend 2-4 times as much as the next country that has almost universal healthcare. and our quality is much lower too. alot of top of the line medication, even generics are expensive(but thats probably another industry problem we havnt deal with i,
What if, hear me out, it was health CARE and not INSURANCE? I’m an American, and we’re so programmed to discuss this as insurance (to stop something bad) rather than health care (a holistic set of benefits). AFAIK, the rest of the world sees this as the normal approach (care).
opting forforced intoI’m co-opting your comment, so apologies if you don’t approve.
It’s a bit of both, opting and forced. At this point, I’ve commented in dozens of threads about my personal situation, so apologies to those folks who are seeing yet another comment with the same sentiment from me.
In a nutshell, I was laid off this year due to the Trump administration, due to a variety of factors I have not returned to work, and I’m using the ACA for health insurance. While I still have several days to make a final decision, I can see an argument for classifying my situation as “opting for no coverage” versus being forced.
Here’s the thing, in my entire adult life, health insurance has always cost me more than it saved me. Literally, 2025 is the very first year where I might have broken even, and that was only because I had an unexpected health emergency.
On top of that, when you’re unemployed and in a financially strained situation, being 1 million dollars in debt is pretty much the same as being 10 thousand dollars in debt. Can’t repay either. So, having health insurance with a maximum out of pocket is still no guarantee that I won’t end up in financial ruin.
More importantly, the degree to which health care costs are going up this year is unprecedented for a lot of people. The raw, unsubsidized cost of ACA plans is increasing close to 50%. Bronze plans (lowest) cost as much as silver plans did for 2025, silver plans cost as much as gold plans. In addition, all the out of pocket expenditures are increasing like copays, coinsurance, deductibles, and maximum out of pocket. But that’s not all, the cost of prescriptions and medical costs in general are increasing due to inflation, so even if the insurance is 100% comparable to last year, we’re still paying much more. The final and often the most significant blow is that these tax credits / incentives are going away. These were significant, they made the lower tier plans free for those most in need and provided significant relief for people earning up to around $60,000. All combined, the cost increases associated with these plans is honestly absurd. Truly a WHAT THE FUCK situation.
Even if we all agreed that this is how it needs to be, no sensible and reasonable policy would let this all happen at once. At a minimum, these increases and changes should have been phased in slowly enough to allow people to adapt and there should have been much more communication that this was on the horizon. I say that, because after I was laid off this year, I was directed towards an ACA plan (versus COBRA coverage, if you don’t know what that is, just know that it’s expensive and limited) with no mention of this time bomb about to explode. That’s a major failure on all fronts.
So, apologies continue, this ended up being yet another novel on the subject. But it’s important that people know how terrible and complicated this situation is.
In summary (i.e. the TLDR) is that I could probably afford the very cheapest and shittiest plans offered through the ACA for 2026, but at the end of the day I have to look at the risk versus the cost, and realistically, the case could be made that if I choose not to get a plan, I’d be opting for no coverage versus being forced. Not that my situation is the norm, but I’m also sure I’m not the only person in the USA in this kind of predicament.
I noticed you mentioned that insurance has always “cost me more than it saved me”. I feel like this is a fundamental issue in how Americans think about health insurance.
Insurance should cost you more than you get out, if everyone got more than they put in it would be insolvent. However, Healthcare in the US has become so broken that insurance=access to many.
We shouldn’t need insurance to access our primary care doctors or basic treatment, but for some reason it’s designed around this complicated opaque system.
I’m sure many Americans do look at health insurance in that one singular way, no different than how some people are single issue voters. However, taking that phrase out of the context I presented it misses out on the statement I was making.
For people in my situation, we’re fully aware that insurance of all types generally costs more than you get out. And I think most Americans understand that fundamentally, at least to some degree, but that’s not super relevant one way or the other.
Either way, the point I was making is that not everyone is being forced out of coverage, many of us are opting out or at least considering it.
We do have to look at it from the lens of cost versus value. It’s not that I can’t afford to go to the doctor and buy my healthcare supplies without insurance, it’s that I might not be able to afford to those things if I’m also paying for insurance. Basically, it has to save me more than it costs in my situation. But the other aspect of this decision that gets lost if you only focus on the “cost me more than it saved me” is that the plan would need to offer meaningful financial protection against disaster (i.e. the traditional role of insurance), but with maximum out of pocket amounts being so high, there’s little to no value there. Which means the affordability part (i.e. costs more than it saves) becomes a much more important aspect to consider.
Sure, insurance mathematically needs to be a losing deal for most people. Except health insurance in the US costs like $10k-$20k per year more than what you get out (if you’re healthy), even the cheap plans. Not exactly an easy pill to swallow, especially if you’re average or below income. We mask the cost by having employers pay for most of it if you’re employed and get benefits, but that cost is included in your total compensation package and effectively coming out of your wages even if your paystub pretends it isn’t.
Oh yeah, it’s totally outrageous how much money we pay in and how little actual healthcare providers get. The system is just so broken.
its also extremely convoluted too. A private physician will probably need to hire tech to deal with the insurance, and then you have to worry about what is covered and you must call the insurance companies to verify coverage, its all messy.
we spend 2-4 times as much as the next country that has almost universal healthcare. and our quality is much lower too. alot of top of the line medication, even generics are expensive(but thats probably another industry problem we havnt deal with i,
What if, hear me out, it was health CARE and not INSURANCE? I’m an American, and we’re so programmed to discuss this as insurance (to stop something bad) rather than health care (a holistic set of benefits). AFAIK, the rest of the world sees this as the normal approach (care).
Yeah, that’s what I was trying to get at. The whole middleman system that acts as a barrier to just regular care is beyond broken.