\u201cIt\u2019s hard for me to create a story where those dynamics will go away and trends will come down,\u201d said Mike Guerriere, chief actuary for Blue Cross Blue Shield of Massachusetts. \u201cAs long as we\u2019re in this high-trend environment, with all we do to try to mitigate that, I would expect we\u2019re still going to be in a high-premium environment.\u201d<\/p>\n
And the health coverage picture is expected to get much worse because of a separate set of changes from Washington, D.C., to the federal-state Medicaid program. New work requirements and eligibility checks that will go into effect in January could result in hundreds of thousands<\/a> in Massachusetts losing access to Medicaid.<\/p>\n \u201cThis is just the start of moving us toward further unraveling of the commitment we\u2019ve had and demonstrated to near universal health insurance and coverage in Massachusetts,\u201d said Kaitlyn Kenney Walsh, chief executive at the Blue Cross Blue Shield of Massachusetts Foundation, an independent policy analysis organization.<\/p>\n The expiration of expanded ACA subsidies for low- and middle-income residents was at the crux of the fight on Capitol Hill last year that led to the longest government shutdown in history. The subsidies were broadened during the Biden administration to include people earning more than 400 percent of the federal poverty level. <\/p>\n During the shutdown, legislators who fought the losing battle<\/a> to preserve the subsidies argued that allowing them to expire would cost millions their access to insurance. <\/p>\n Since the subsidies expired, many were left performing an impossible calculus: How much could they afford for health coverage without subsidies? And at what point is coverage no longer worth it? <\/p>\n Kelley Kassa, a 56-year-old from Watertown with diabetes, was among those who decided to go without insurance. Last year, her monthly premium for insurance through the connector was $357, with $50 copays for doctor visits. <\/p>\n This year, plans she considered had monthly premiums of $1,000 due to the reduced subsidies. Moreover, she would have been on the hook for $3,800 in out of pocket expenses before the insurance covered any doctor visits, and $10,000 out of pocket before prescription coverage kicked in. Her diabetes medication costs roughly $3,300 annually, she said. She couldn\u2019t afford both the insurance and the medication, she said. <\/p>\n \u201cDo I want to live, because I need this medicine to live, or do I pay my premiums?\u201d Kassa said. <\/p>\n She works for a global industry analysis firm and coaches rowers, but the connector was her best option for health insurance, she said. <\/p>\n \u201cI do not understand how people who make less than six figures can afford health insurance,\u201d she said.<\/p>\n Health authorities in the Trump administration say the decline in enrollment shows the program is filtering out undocumented immigrants and fraudsters. <\/p>\n \u201cThe only people who lost coverage were people who were never entitled to coverage,\u201d said Robert F. Kennedy Jr., the secretary of health, in a congressional hearing in April. <\/p>\n But others say it is undisputed that thousands of people depended on those subsidies for access to health coverage. <\/p>\n \u201cThere\u2019s certainly not evidence that there\u2019s fraud at anything like this level,\u201d said Gruber, the MIT economist. \u201cThe administration\u2019s efforts were designed to take people off health insurance.\u201d<\/p>\n For these families, living without insurance is a blow not just to health care access, but to their finances and sense of stability. <\/p>\n Zoe Sherman, 46, of Boston, turned to the Health Connector in 2025 after leaving her job as a university professor. Deciphering coverage options for herself, her husband, and their teenage child was frustrating, but ultimately fruitful. They qualified for about $600 per month in subsidies, leaving them to pay $1,700 for a Harvard-Pilgrim plan that all of their primary care providers accepted. <\/p>\n Then came the renewal notice. <\/p>\n Because the federal government reduced subsidy options, Sherman would no longer receive financial assistance. The plan they were on in 2025 was also upping its premium. The family would have to pay $3,000 per month if they renewed the same coverage. <\/p>\n Sherman found another plan on the marketplace that cost about the same as the family paid in 2025 but came with far fewer benefits. The household deductible reached $5,800 and the out of pocket maximum was more than $20,000. <\/p>\n The plan also wasn\u2019t accepted by their child\u2019s pediatrician. But their teenager soon turns 18 and can get an adult primary care provider.<\/p>\n \u201cWe figured it was a compromise we could make,\u201d Sherman said.<\/p>\n As for next year, Sherman said she doesn\u2019t know what the family will do, but expects they would almost certainly continue to pay for insurance through the marketplace. <\/p>\n \u201cBut I don\u2019t know how extreme and absurd the prices could be,\u201d Sherman said. \u201cMaybe there is a threshold past which we just can\u2019t do it. I\u2019m not sure.\u201d<\/p>\n Marin Wolf can be reached at marin.wolf@globe.com<\/a>. Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>.<\/p>\n![\"Kelley](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/05\/BVPWBFL6SYHKBCQPG6NRYT2DVQ.jpg\")
Kelley Kassa at the Community Rowing Boathouse, where she works in Brighton.John Tlumacki\/Globe Staff<\/p>\n