Political experts believe that rising costs and inflation played a significant role in the 2024 presidential election. Many voters felt squeezed by the increasing prices of groceries and other essentials. At a rally in Pennsylvania in December 2025, President Donald Trump promised to “make America affordable again.” A recent KFF poll highlights just how worried Americans are about healthcare costs: over 60% of respondents expressed concern, and 41% reported struggles with medical debt.
In recent years, the United States faced its longest federal government shutdown ever. The main issue was the affordability of healthcare for low- and middle-income families. The debate centered around enhanced Affordable Care Act (ACA) Marketplace subsidies, which help make health insurance more affordable. These premium tax credits, introduced in 2021 under the American Rescue Plan Act, were extended the following year but are set to expire at the end of 2025.
During the open enrollment period in 2025, over 24 million Americans signed up for health insurance. Most significant growth occurred in states like Texas that hadn’t expanded Medicaid, seeing increases of up to 255%. But without the enhanced premium tax credits in 2026, many will face premium increases of over 100%. If they can’t pay, they risk losing coverage and won’t be able to reapply until the next enrollment period unless they experience a significant life change.
Affordability is crucial for health coverage. Research shows that for every 1% rise in ACA premiums, there’s an estimated 1.7% drop in enrollment. Insurers plan to increase premiums by about 26% in 2026. Families that previously received subsidies could see an average increase of 114% in their premiums, putting healthcare costs in competition with essential expenses like housing and food.
For instance, a family of four making $128,921—401% above the Federal Poverty Level—might think they’re doing well. However, experts argue that this income level doesn’t guarantee financial security. The Federal Poverty Level itself is outdated and doesn’t reflect today’s cost of living, having been set in the 1960s based solely on food costs.
Some financial experts suggest that a more realistic living wage should be around $140,000 for a family of four, considering the actual expenses in today’s economy. For example, in Washington, D.C., families need approximately $138,333 just to maintain a modest standard of living, not even accounting for health insurance costs. Without subsidies, they could face annual premiums exceeding $21,500, which would significantly strain their budget.
In Boise, Idaho, the picture is slightly different. A family of four would need about $98,387 to cover their basic costs, which still doesn’t include health care. With premium costs on the rise, they too would face tough choices.
On a personal level, healthcare affordability affects many lives. For instance, Heidi Allen shares the tragic story of her sister Rachel, who died uninsured at 44, just weeks after being diagnosed with cancer. Working as a nurse, Rachel found employer-sponsored insurance unaffordable, and the ACA Marketplace options didn’t fit her budget either. In the end, she missed out on crucial care that could have saved her life. This highlights that the struggle for affordable healthcare is not a political debate; it’s a heartbreaking reality for countless families.
Affordability matters more now than ever. As we head into 2026, the lack of a passed bill means many will face stark choices about their health and finances.
For context, the healthcare landscape is constantly shifting. Data from the Center for Disease Control and Prevention shows that inadequate access to healthcare can lead to severe outcomes, emphasizing the urgency of addressing affordability in this country.
