Natalie Richards feels the pressure. Her health insurance premium shot up from $3 to $164 a month earlier this year. As a single mom working as a dishwasher at Chili’s, that steep price is too much for her already tight budget. Many like her rely on the Affordable Care Act marketplace since their jobs don’t provide health insurance.
Richards worries about losing her coverage entirely. “It’s life or death,” she says. She depends on this insurance for medications and therapy to manage her ADHD. Without treatment, everyday tasks can feel overwhelming.
For years, she has worked in jobs without employer-based insurance, so the marketplace has been her safety net. The support she receives helps her maintain a better quality of life, allowing her to focus on solutions rather than just survival.
However, many Americans are now feeling the crunch. Millions lost out on ACA subsidies that helped low- and middle-income families pay for healthcare when these credits expired at the end of December 2022. This change drastically impacted those in flexible jobs or without employer coverage.
In January alone, enrollment in the ACA marketplace dropped by 1.4 million, a worrying trend that experts predict will continue. Early in 2025, about 24 million individuals were enrolled in ACA plans, numbers that had climbed steadily since enhanced subsidies were introduced in 2021. But now, many are facing difficult decisions.
Richards, for instance, might soon have to let her plan lapse due to unpaid premiums. This potential loss terrifies her. “The things I desperately need right now, I don’t have access to,” she admits. It’s not just health insurance—it’s about stability.
With a part-time job paying just above minimum wage, housing and food take priority in her budget. She lacks a car, making it harder to attend appointments. Without insurance, she can’t afford medical visits. So, she finds herself in “crisis mode,” considering home treatment for illnesses and skipping prescription refills.
Richards is particularly anxious about losing mental health support. If her marketplace plan lapses, so does her access to therapy and the medication she needs. This affects not just her but her ability to parent her teenagers effectively.
Texas, where she lives, hasn’t expanded Medicaid under the ACA, further limiting her options. The state only offers Medicaid to low-income children, pregnant women, seniors, and disabled individuals, leaving many like Richards in a lurch.
Healthcare access is a mounting issue in America. A recent survey showed that nearly 30% of adults have avoided necessary medical care due to cost concerns. Richards is not alone; many struggle to balance health needs with financial realities.
As the political climate shifts and subsidies fade, millions could be left without critical support. For people like Natalie, losing this coverage means losing much more than just health insurance. It’s about security, stability, and the ability to care for themselves and their loved ones.
For more about the impact of ACA subsidies, check out this report from the Kaiser Family Foundation.
