Darkness visible: Signs of an impending health crisis

By Dennis Archambault

Health care affordability has become a largely invisible crisis—one that is increasingly felt by middle-income households. Many are struggling not only to pay for health insurance premiums, deductibles, and co-pays, but also to cover basic living expenses such as food, transportation, and utilities. These financial pressures—often referred to as the social determinants of health—are leading some individuals to forgo health insurance altogether, compounding their risk.

In February, the Centers for Medicare and Medicaid reported that enrollment in Affordable Care Act plans for 2026 is down by more than 1 million people compared with the same time last year. The expiration of enhanced premium tax credits has driven premiums up by 114 percent. As a result, it remains uncertain how many enrollees will ultimately be able to make their required payments.

These rising costs are shaping major life decisions. Many middle-income individuals are hesitant to change jobs or retire and are postponing milestones such as starting a family or purchasing a home. Some are even skipping meals to manage expenses. According to reporting by The New York Times, citing a West Health–Gallup poll, households earning around $240,000 are delaying major life investments—including career moves, homeownership, and family planning. This trend extends to those with employer-sponsored insurance, where costs are also rising sharply. Annual family premiums can reach as high as $27,000, not including deductibles and co-pays. Those in poorer health face even greater strain, often falling behind on utility bills or cutting back on essential needs. As Tim Lash, president of the West Health Policy Center, noted, the situation is worsening and affecting people every day.

One-third of respondents in the West Health–Gallup poll—representing an estimated 82 million Americans—report borrowing money or going into debt due to health care costs. This creates a troubling paradox: who can afford to purchase health insurance, and who can afford to go without it?

The Kaiser Family Foundation reported similar findings in February, noting that people enrolled in Affordable Care Act plans and nearing retirement age—who make up about half of Marketplace participants—are experiencing significant premium increases following the expiration of federal subsidies.

Delays in seeking primary care and avoiding diagnostic tests will likely lead to worsening health outcomes and reduced economic stability for many households. The potential rollback of expanded Medicaid would further intensify pressure on community health centers already serving vulnerable populations.

While some elected officials dispute the severity of the crisis, multiple surveys suggest otherwise. Unfortunately, the full impact may only become evident over time, reflected in declining health outcomes and a gradual erosion of quality of life.

Dennis Archambault is vice president of Public Affairs for Authority Health.