Stacey Hilton won’t have health insurance in 2026.
It’s a scary reality for the 55-year-old registered nurse from West Michigan, but one she determined is warranted by rising health care premiums.
Hilton knows about her high blood pressure and fibromyalgia. Scarier are the unknowns awaiting her in the year to come.
“I’m trying to watch out for my health by getting better sleep, by trying to eat better, by exercising and by taking it easy on my body,” said Hilton, who works part-time nursing roles at a pair of Muskegon facilities.
“Fingers crossed I make it through the year without catastrophe.”
Hilton was among the more than 24 million Americans who got health insurance through the Affordable Care Act (ACA) marketplace in 2025. She was also one of the many who saw their out-of-pocket costs increase significantly this year due to the expiration of COVID-19-era subsidies.
People with insurance through the ACA marketplace tend to be self-employed, small business employees, part-time workers, students, early retirees or unemployed.
Tax credits can lower costs for people with a household income between 100% and 400% of the federal poverty line. For 2026, the poverty line is $15,960 for family of one and $33,000 for family of four.
Extended tax credits during the COVID-19 pandemic made more people eligible for reduced health insurance costs, but those subsidies from 2021 expired Dec. 31, 2025.
Federal lawmakers considered extending the subsidies or coming up with a replacement savings mechanism, but failed to reach an agreement, setting the course for higher insurance costs in 2026.
San Francisco nonprofit KFF estimated the average increase would be about 114% in 2026. Their calculation wasn’t far off for Hilton, whose bill doubled to about $800 per month.
“This will be the first year I’ve ever gone without health insurance,” Hilton said.
“In a country with so much, none of us should go without health care or worry about bankruptcy if we should get ill, or to not be able to treat something that would otherwise be treated.”
As of late January, there were 497,064 Michiganders enrolled in plans through the healthcare.gov marketplace — about 34,000 fewer than the same time last year. Nationwide, sign-ups were down by more than 1 million people and fell to the lowest point since 2020.
A January poll from KFF found two-thirds of respondents nationwide were somewhat or very worried about affording health care. That exceeded concerns about affording utilities, food, housing and gas.
The full ACA enrollment picture won’t come into focus until later in the year, when unpaid premiums lower actual enrollment totals, according to KFF.
‘I wish I felt a sense of relief’
It took some shopping, but Kendra Bonga found a health plan through the ACA marketplace that fit her budget for 2026.
The self-employed upholsterer from Grand Rapids paid about $180 per month for a Blue Cross Blue Shield plan the prior two years, which covered her weekly doctor and therapist appointments.
The same plan in 2026 was going to cost $585 per month, double her deductible, and it didn’t cover her preferred therapists. And that’s with the help of remaining income-based ACA subsidies.
Bonga, 45, found a new plan with a slightly lower monthly payment, but a deductible three times higher. Altogether, it will cost about $600 more per year — a price she was willing to pay, despite limited in-network providers, given her existing caregivers were covered.
“I’m definitely grateful it didn’t go up more,” she said. “I wish I felt a sense of relief, but I honestly feel like I’m waiting for the other ball to drop. I’m waiting for someone to tell me I need something not available through Mercy or Pine Rest and then I will be screwed.”
When lawmakers adopted the ACA in 2010, the primary goal was to help increase access to affordable health insurance.
The legislation was successful in reducing the uninsured rate for people younger than 65. That number declined from 17.8% in 2010 to 10.9% in 2015, and has stayed between 10.9% and 9.5% in the decade to follow.
Where Obamacare fell short was the affordability part, said Dr. Mark Fendrick, a University of Michigan physician and professor who helped write the ACA.
“Although many, many millions of people got insurance, they were underinsured,” said Fendrick, who has spent decades studying health insurance and health care costs. He serves as director of U-M’s Michigan Value-Based Insurance Design program.
Fendrick said the reports of people going without health insurance entirely in 2026 are troubling and make him feel like he went back in time to before the ACA marketplace was created.
“Here we are, back to the future,” he said. “I never thought we’d be back here.”
What to do if you can’t afford insurance
Fendrick knows that for many, finding thousands in the budget to cover deductibles for even the cheapest, “least-generous” health care plan is a daunting task.
But that pales in comparison, he said, to the millions of dollars in medical bills that the uninsured could face following an unforeseen emergency or diagnosis.
“Even when people recover physically and emotionally from these devastating catastrophic events, it’s often the financial ramifications that actually impact their lives forever,” Fendrick said. “It’s always a good idea to have some insurance, even if it’s not generous, to prevent you from an absolutely devastating life impacting event.”
For those who truly can’t afford a plan, know there are other options.
Most of Michigan’s major health systems have programs for people in financial need. Fendrick advises those patients to be upfront with their caregiver regarding their financial limitations. They may recommend a cheaper test or prescribe a generic medication.
“Don’t put off health care and know that you can negotiate,” he said. “When you’re in a position of self-pay, do not be afraid to talk about a payment program or a way to negotiate what the bill is.”
Michigan has a website to help match low-income families and individuals with free or low-cost care for people without insurance. For example, community health centers can charge based on a sliding income scale and may be able to refer patients to a provider that works with uninsured patients.
Many local health departments offer free vaccinations, family planning services and no cost testing for the flu, COVID, tuberculosis and sexually transmitted infections.
There are also organizations like the Patient Assistance Network, which provides financial assistance for more than 80 diseases and chronic illnesses, and GoodRx, which provides prescription drug coupons and access to cheaper, generic drugs.
A needed paradigm shift
Rising health care costs isn’t solely an ACA issue.
Randi Boyd was shocked when her health care premiums increased from $160 to $328 weekly for her family of four. She gets insurance through her employer, Amazon.
The Grand Blanc mother of two called the annual cost increase “highway robbery.”
“We are already seeing a hit to our ability to provide groceries for our children,” she said.
Rising health costs in America is a complex issue and one that needs to be addressed with a difficult paradigm shift, Fendrick said. He said there’s a need to shift away from a “fee for service” system to a value-based payment system that prioritizes healthy outcomes. It’s an ongoing shift, albeit slowly.
“The fact that clinicians got paid prices they set for whatever they wanted, regardless of it working, that’s been a hard paradigm to shift,” he said.
Fendrick likened it to a golfer getting paid per swing rather than getting paid to put the ball in the hole.
He also quipped: Never ask a barber if you need a haircut.
“For the money we’re spending, if we actually got the gold medal in terms of health outcomes, then I would say keep spending,” Fendrick said, making a reference to the ongoing Winter Olympics and national health care spending.
“But because we spend the highest and we don’t even make it onto the medal platform, not even close, that suggests we have work to do.”
For Hilton, the part-time nurse in Muskegon, she doesn’t know what 2026 will bring. She is hoping to secure temporary insurance if she can get work as a travel nurse, though that isn’t guaranteed.
In the meantime, her biggest concerns are the “what ifs.”
What if she were to suffer a cardiac arrest or stroke? Or develop cancer without health insurance to help cover the exorbitant costs?
“I’m hoping for the best this year that nothing significant happens that I won’t be able to cover on my own,” she said.