ACA Subsidies Crisis: Health Insurance Workarounds Explained
- Some Americans are making big leaps to manage the cost of health care.
- When he stops to think about it, mathew says, his situation feels kind of ridiculous.
- "I find myself in the middle of some sort of rom-com plot," he says.
Marrying a roommate for insurance? Some Americans are making big leaps to manage the cost of health care.
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When he stops to think about it, mathew says, his situation feels kind of ridiculous.
“I find myself in the middle of some sort of rom-com plot,” he says. “For me to be able to see my doctor to tend to my autoimmune disease, I had to marry my best friend – it’s like some weird twisted plot of Will and Grace.”
Mathew asked NPR not to use his full name because he fears repercussions from his health insurance company if it finds out he got married to obtain coverage.
He is not the firstBut his decision was forced by the cost crisis facing many of the roughly 24 million people who get their health care via Affordable Care Act marketplaces. Enhanced subsidies that made plans affordable for many people expired at the end of 2025 and Congress failed to extend them before the 2026 plan year. Millions of people face untenable monthly premium prices – as much as the cost of a mortgage for some families.
Congressional lawmakers are back at the table working toward a deal that could revive the enhanced subsidies.In the meantime,some have decided to forgo insurance or make choice plans.
ACA Subsidies Expire, Raising Healthcare Costs for Millions
Mathew, a 40-year-old resident of a small town in Michigan wiht an autoimmune condition, faces a premium increase from $181 to over $427 per month due to the expiration of Affordable Care Act (ACA) subsidies at the end of 2025. He currently obtains coverage through the ACA marketplace because his employer does not offer health insurance.
“That’s so weird”
Mathew expressed concern in the summer of 2025 regarding the potential lapse of ACA subsidies. He relies on medication transfusions for his condition and found his $181 monthly premium for 2025 manageable.
The enhanced subsidies, initially expanded under the American Rescue Plan Act of 2021, expired on December 31, 2025. Without the subsidies, Mathew’s premium is projected to increase to $427 per month, a cost he stated he cannot afford.