Yves here. KFF Health News today is giving prominent play to the US health insurance crisis triggered by big increases in 2026 across nearly all plans, plus the additional kick in the gut for many of the loss of enhanced Obamacare subsidies. One of the big objectives of Obamacare was to reduce the level of uninsured, which did happen (although a big portion of that was due to Medicaid expansion). That level had fallen from nearly 15% to under 8%. The Urban Institute had estimated that 4.8 million would “lose” as be unable to afford individual insurance if the enhanced subsidies lapsed. That is a 21% of the uninsured. This forecast did not allow for the additional impact of the hefty increase in premiums in 2026.
The lead KFF story, When Health Insurance Costs More Than the Mortgage, gives a sense of how extreme the health insurance cost pressures have become. Key sections:
When Noah Hulsman, who owns a skate shop in Louisville, Kentucky, learned he no longer qualified for federal subsidies to help him pay for his “gold” Affordable Care Act health plan, the 37-year-old opted for skimpier coverage. But the deductible is about a quarter of his yearly income.
Loretta Forbes realized she would have to drop her plan after her monthly ACA marketplace premiums jumped tenfold in 2026. So the 56-year-old, who lives outside Nashville, Tennessee, started rationing her rheumatoid arthritis medications. Her husband, Jim, gave up on his fledgling handyman business and started looking for a job with insurance coverage.
And when Nicole Wipp learned the monthly premium for her family’s ACA plan would be more than their mortgage payment, she and her husband decided to drop their family plan and buy coverage only for their 15-year-old son.
After crunching the numbers, Wipp, 54, a self-employed lawyer in Aiken, South Carolina, said she and her family made the tough call.
“We decided that, ultimately, it would be better for us to gamble.”…
Hulsman, Forbes, and Wipp don’t qualify for Medicaid, the public insurance program for those with low incomes or disabilities. But like many others, they are being squeezed by the increasing costs of groceries, housing, and other necessities…
More than 80% of Americans said their cost of living has increased in the past year, according to a January poll from KFF, a health information nonprofit that includes KFF Health News. Health care costs ranked at the top of their concerns, with about two-thirds saying that they are somewhat or very worried about affording health care — more than said the same about other necessities, such as food and housing, the poll found.
Now to the main event: what if anything Americans who can no longer afford insurance can do to try to get by. “Don’t get sick” is easier said than done, but wearing a mask, at least in the winter and when contagion levels are high, should be on the list. It’s not hard to detect that the meant-to-be-helpful suggestions below effectively confirm that the big cost savers will be not going to doctors and relying on emergency rooms when things get dire.
By Renuka Rayasam. Originally published at KFF Health News
Health policy changes in Washington will ripple through the country, resulting in millions of Americans losing their Medicaid or Affordable Care Act coverage. But there are still ways to find care.
Over the next decade, the GOP’s One Big Beautiful Bill Act is expected to slash nearly $1 trillion in spending from Medicaid, the state-federal program for people with low incomes and disabilities. The implementation of new work rules will cause some beneficiaries to lose their Medicaid coverage.
Millions of Americans are facing enormous increases in their out-of-pocket costs for ACA coverage. So far, 1.2 million fewer people have signed up for Obamacare plans compared with last year, and health policy analysts estimate more will lose coverage as they fail to pay their premiums.
Health costs are a top concern for Americans. Two-thirds of the public say they are somewhat or very worried about affording health care, more than express the same worries about utilities, food, housing, or gas, according to a January poll from KFF, a health information nonprofit that includes KFF Health News.
“All of this pain just doesn’t have to be there,” said Cheryl Fish-Parcham, director of private coverage at the health consumer group Families USA.
Doctors and health policy researchers say health coverage, of any kind, is the best protection against major medical debt.
Caitlin Donovan, a senior director at the Patient Advocate Foundation, recommends exhausting every available option for health coverage before going uninsured.
Even a high-deductible plan can protect patients from medical bankruptcy “if the absolute worst-case scenario happens,” she said.
Here are five ways that the uninsured can find affordable care.
1. Don’t Be Afraid To Talk With Your Doctor About Money
Patients can be hesitant to tell their doctors they’re uninsured or be wary of expressing concern about being able to afford care.
But some hospitals, physicians, and other providers offer cheaper cash pay options, said Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF.
Often prices are negotiable. “Always ask,” she said.
Health care providers can make adjustments if they know patients are worried about money, said Ateev Mehrotra, a doctor and researcher at Brown University.
“If my patient tells me, ‘Doc, I’m gonna have to pay for this out-of-pocket,’ I’m gonna make a different risk calculus,” Mehrotra said.
That doesn’t mean a patient won’t get the care they need, he said. A doctor, for instance, might order an ultrasound instead of an MRI, which is more expensive.
2. Search for Providers That Specifically Work With Uninsured Patients
If your usual provider won’t budge on prices, then search for providers that cater to patients without insurance.
Federally qualified health centers, or FQHCs, and other community clinics offer routine and non-emergency care, such as treatment for flu or infection, for low-income residents and the uninsured. Community health centers charge based on a sliding scale and see 52 million patients annually in some of the country’s most underserved areas, according to the National Association of Community Health Centers.
The Trump administration has made funding cuts that might lead some of the country’s approximately 1,500 FQHCs to close or cut services. But the administration still maintains a site to find a local center.
Planned Parenthood also accepts uninsured patients. Its centers test for sexually transmitted diseases, provide birth control options, and offer postpartum and gender-affirming care and other services.
And the National Association of Free & Charitable Clinics also offers a tool to help people find free or low-cost care.
Most community clinics don’t offer specialty care, but they can usually refer patients who need more intensive services to providers willing to work with uninsured patients.
And academic medical centers tend to have more charity care programs that help uninsured patients lower their bills.
“If you’re uninsured or even underinsured, you might be able to qualify for a significant discount on the cost of your care,” Cox said.
Still, be wary of heading to the emergency room, which is the most expensive place to get care. While ERs are federally required to stabilize all patients regardless of their ability to pay, they can still leave you with a big bill — and often do.
3. Call Your Local Health Department
Health services vary widely from county to county, but many offer free vaccinations, family planning services, and testing for sexually transmitted infections, as well as for flu, covid, and tuberculosis.
Some county health departments also offer more advanced care, such as dental services and mental health or substance abuse programs. And some states have consumer assistance programs that can guide residents in finding care, Fish-Parcham said.
In addition, the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program makes free or low-cost breast and cervical cancer screenings available to low-income women in all states and territories. And some states cover screenings for other types of cancer as well.
4. It’s Easier To Shop Around for Drugs Than Doctors
Don’t just fill your prescription at the closest pharmacy. Instead, research generic drug options and look around for the best price on brand names.
A handful of sites such as GoodRx and WellRx offer comparison shopping tools and information on other ways to get drug discounts.
And some retailers offer low-cost access to common prescription drugs — at prices cheaper than you would find if you had insurance. Walmart, for instance, sells 90-day prescriptions of dozens of generic versions of drugs for $10. As do Target, Costco, and a new site called the Cost Plus Drug Company.
Many drugmakers also offer patient assistance programs, coupons, and rebates on some medications. Check their websites for details on how to apply.
States also offer drug assistance programs. The steps to qualify and types of drugs vary, but this tool has a list of programs and how they work.
Joining a clinical trial is another way to access treatment. The National Institutes of Health and its National Cancer Institute have lists, but patients must first meet the criteria. Clinical trials aren’t necessarily free, even with insurance, Donovan said, so be sure to ask about any associated costs.
5. Your Diagnosis Might Lead You to Specialized Resources
Patients with a specific diagnosis might have additional options for specialty treatment.
For example, someone with breast cancer should check with the American Cancer Society and the nonprofit Susan G. Komen organization, Cox said.
The Patient Advocate Foundation hosts a list of vetted foundations that can help offset the cost of medical bills and provide other resources such as transportation and lodging, Donovan said. Just type in basic information such as age, location, and diagnosis to see what is available.
Disease-specific foundations such as those for lupus or irritable bowel syndrome can also steer patients to free or low-cost resources or cover some costs of care, Donovan said.
“Everything is out there,” she said.
As you research affordable care options, don’t be tricked by plans that look like health insurance but don’t offer guaranteed protection against big bills.
Some short-term plans and health care sharing ministries might seem like good deals, but read the fine print. Some red flags to look for: too-good-to-be-true monthly payments; no coverage for preexisting conditions; morality clauses such as those prohibiting the use of alcohol or drugs; or a lack of coverage for benefits such as mental health counseling that are required in ACA plans.
KFF Health News correspondent Sam Whitehead contributed to this report.
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I would suggest a point #6.
6. Join the Confraternity of Saint Luigi the Adjuster.
No one publicly mentions National Health today. Curious that.
“National Health” and its poor cousin, “Medicare For All” got talked to death by the Democrats, before they decided it was too expensive and anti-market. Plus, we needed that money for Ukraine and Israel, after all. And if everyone went to college and got graduate degrees and worked in “innovation” businesses, they would be able to afford decent insurance. So there. /s
There was a link here a few weeks back to an article saying the federal definition of the “poverty line” was way too low and had not been getting realistically updated for decades. That should definitely be fixed, because the limits for Medicaid eligibility are obscenely low. But fixing that might force everyone to recognize that we have a huge poverty problem in this country, and that many people who still are trying to convince themselves that they are “middle class” are actually poor, sometimes very poor. How would the Lie Factories spin that?
This is that link:
It would be sad if absent the subsidies to the insurance companies (“people” are not losing subsidies, insurance co.s are losing subsidies) the insurance companies have to lower rates or lose customers as the grifters faced in 2008 and were bailed out in tandem with the banks. All those premiums go to wall st after all. Thanks Obama! Hope you’re enjoying all those far flung mansions. They do all work for the same people and it’s not you or me.
A giant meteor taking out D.C. would be great. Or maybe that carrington event will happen.
One way or another, this darkness got to give
New Speedway Boogie
https://www.youtube.com/watch?v=_nOpJMQ3-VE
If DC is taken out, social security would end.
Trying to get healthcare as a second job, or third job.
“That doesn’t mean a patient won’t get the care they need, he said. A doctor, for instance, might order an ultrasound instead of an MRI, which is more expensive.”
It seems to me that there are two possibilities here:
1. Unnecessary testing is being prescribed in order to jack up costs. Unnecessary testing is not providing patients with the care they need. Jacking up costs is straight up theft if not assault.
2. Substandard care is being substituted for optimal care. Substandard care is not providing patients with the care they need.
I suspect that both are true. The US system does not provide patients with the care they need. That is the bottom line.
As a Canadian, the US system continues to make our crumbling health care system look good. Given how bad it is becoming – that makes the US system look truly frightening.
First paragraph. Should be Medicaid expansion, not Medicare.
Aargh, thanks! Fixing…
#7. Have an ER doc, primary care physician, or family nurse practitioner in your family.
#8. Develop an unusually high health literacy, especially in your children. Take a Wilderness First Responder class. Volunteer as a street medic in Minneapolis. Get familiar with Where There Is No Doctor, herbal first aid, and Common Simple Emergencies (http://agk.sdf.org/lib/). (See also this Where There Is No Doctor fanfic: http://agk.sdf.org/docs/zine/thekid.txt).
#9. Pursue a reasonable ideal of health which does not imagine everyone is independent. We are dependent/ interdependent.
#10. Mail-order overseas pharmacies in Hong Kong, India, and Vanatu. Or veterinary medications. Not as a foundation, but as needed on a base of sometimes tough, radical, sustained lifestyle changes. Like, don’t smoke.
These are EXCELLENT suggestions!!!
Perhaps a variant of #7, if you have a health care professional as a neighbor, see if you can make them a friend without being gross or manipulative about it.
And if you have a garden…#11, bone up on medical/medicinal herbs and grow/cure ones that are relevant to your actual and possible medical issues.
My pastor ran out of insulin last week while he and his wife were sick with flu. He didn’t say anything about it last week because he was embarrassed, but while he was stumbling over his words and red-faced during his sermon Sunday, he sheepishly confessed he’d run out of insulin and his sugar was high.
After church he was instantly ambushed by me (a nurse) and a physician in the congregation, and we got him sorted. Other than not demanding a false ideal of health, the other “trick” is to stop imagining you’re a failure if you have to admit you aren’t even at a reasonable baseline.
Assessment skills are more important to be distributed widely than treatment skills. He tests his blood sugar, so the assessment was done and we could focus on the treatment.
When I have asked prescribers for help in a pinch, I share an assessment they trust. Tick bite, positive ID of deer tick, endemic Lyme’s area, no rash or fever, bite likely within last 24 hours, I can send you a photo of the tick. Acute onset vomiting for 12 hours, hard to keep her hydrated, fever of x, contact with someone with similar symptoms.
If you can describe a good assessment, you’re a generally reliable person, your health target is reasonable, your problem is fixable in a short time span, and you know how to rehydrate at home, neighbors who are paramedics, physicians, etc, will be likely to be a help. They constantly see people within an abusive “health” industry who do not know how to do a good assessment, make reasonable goals, rehydrate at home, etc. It’s a treat to use what they know to an emotionally rewarding end.
And see the legal notes at the end of https://safety.branchable.com/how_medical_providers_can_help_protesters/. They have pretty strong liability protections.
As for herbs, in the United States, while it can be a pleasure to grow them, and some like Palma Christa/ Castor plant leaves must be used fresh, generally it’s cheaper to order them dry in bulk from Frontier herbs co-op, or the more expensive Mountain Rose Herbs. Those are the two big wholesalers. We use lemon balm (with L-lysene) when cold sores pop up, nettles cold-brewed overnight during allergy season, catnip for sick babies and toddlers, etc. See the link on herbal first aid in my previous post for a few more. All pretty cheap.
#8 is a great suggestion, especially for the Wilderness First Aid course. One of the things those courses cover is being prepared, taking stock of what is available, and being flexible – and also protecting yourself as the aid giver.
I’d suggest taking a course that is associated with NOLS. That’s what my local outdoors organizations and local volunteer search/rescue use as the standard. I’m doing mine through the Appalachian Mountain Club, which is a non-profit that maintains parts of the Appalachian Trail. See https://activities.outdoors.org/s/?activityTypes=Wilderness+First+Aid
I’d add a #6: if possible, avoid Private Equity owned doctors practices and/or hospitals.
Private Equity Hospital Tracker.
https://pestakeholder.org/private-equity-hospital-tracker/
In one way, US healthcare is superior to Canada’s. In the US, so far, there is no MAID option.
…damning with feint praise
There are plenty of states where MAID [medical assistance in dying] is an option: CA, NY, OR, etc etc
As Kevin C Smith says below, many states. And also way ahead of Canada.
Oregon implemented 1997
Canada MAID 2016
Besides MAID has nothing to do with ‘Canadian healthcare’. In fact there is no such thing. Healthcare in Canada is strictly a provincial jurisdiction. One of the many reasons that healthcare varies so much across the country. Yes, there are Federal rules governing healthcare. But nothing like the centralized control that the Federal government in the US has. And yes, there are also transfer payments to poorer provinces from Ottawa as (what is probably ineffective) a way to equalize quality of care across Canada.
MAID in Canada is better understood in the context of the repatriated Canadian constitution’s Charter of Rights and Freedom of 1982
For the implementation dates of medically assisted suicide
https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/index.aspx
https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#
I don’t understand why moving to another country isn’t an option. Many other developed countries offer high-quality healthcare at much lower prices than the United States.
If you’re older and unable to afford health insurance, how likely are you able to afford and/or get the visa to move abroad? And even then, there isn’t a social network to draw upon for support.
However, medical tourism is a thing. I’ve heard stories first hand and second hand for India, Mexico, Phillipines, and Taiwan.