They’re uninsured after Obamacare became too costly. And they’re far from alone.
They’re uninsured after Obamacare became too costly. And they’re far from alone.
They re uninsured after Obamacare became – Across the country, families are grappling with the financial burden of healthcare, with some choosing to forgo federally subsidized insurance under the Affordable Care Act (ACA) as premiums soar. In Sugar Grove, North Carolina, Ross and Rebecca Tobiassen have found themselves in this situation, having relied on the ACA since its inception in 2014. For years, they managed the rising costs, convinced the benefits outweighed the expenses. But in December, that belief crumbled when Rebecca realized their monthly insurance payment would climb from $130 to over $550. “It doesn’t make sense,” she said. “It’s no longer worth it.”
The Tobiassens operate a small auto shop near Appalachian State University, with Rebecca as the sole employee alongside her husband, Ross. Their business has always been a source of stability, yet the couple now faces uncertainty. Rebecca’s concerns are rooted in Ross’s line of work, which involves handling heavy machinery and sharp tools. A metal ball joint once pierced their garage wall like a projectile, and a falling object crushed Ross’s thumb. In 2020, a recurring corneal infection caused by metal shards led to Ross losing most of his vision in one eye. The medical journey was costly, with specialists estimating a $30,000 price tag for a cornea replacement surgery. At the time, they opted for a less expensive alternative, sacrificing long-term health for immediate financial relief.
Their decision reflects a growing trend: millions of ACA enrollees are canceling coverage as enhanced tax credits, introduced by the Biden administration’s American Rescue Plan Act, expire at the end of 2025. These subsidies had significantly lowered premiums for many families, attracting record enrollment during the pandemic. However, as the tax credits fade, the cost of maintaining coverage has become unsustainable for some. The Tobiassens are among those affected, unable to afford the steep increase in monthly payments. “We’ve known the federal government doesn’t prioritize us,” Rebecca said, “but now it’s glaringly clear.”
A Changing Landscape in Healthcare Costs
Healthcare expenses have steadily climbed since 2022, with the 2026 enrollment period marking a sharp spike. Data from KFF reveals that premiums and deductibles have surged, creating a financial strain for households already struggling to make ends meet. The Centers for Medicare & Medicaid Services are set to publish comprehensive figures on ACA enrollment drops soon, but preliminary findings from KFF, based on Wakely Consulting Group research, suggest coverage could decline by nearly 5.5 million people by 2026. In North Carolina, individual ACA signups for 2026 fell by 22% compared to 2025, a steeper decline than any other state. This translates to over 213,000 fewer people enrolled, signaling a significant shift in the state’s healthcare landscape.
Katie Alexander, who coordinates volunteers for Pisgah Legal Services—a nonprofit aiding low-income residents in securing health insurance—notes that the current situation is unprecedented. During open enrollment, her team worked with approximately 700 clients, nearly 100 of whom opted to drop their ACA coverage. Many chose less comprehensive plans with lower premiums, while others, like the Tobiassens, could no longer afford the full cost. “It’s a major upheaval,” Alexander said. “Folks who previously relied on the ACA are now facing tough choices.”
The affected individuals span diverse professions. Among them are ride-share drivers, artists, and part-time workers with chronic illnesses. Some cannot secure employer-sponsored plans, while others earn too much to qualify for Medicaid. For those without pre-existing conditions, the anxiety is palpable. “Even if you don’t have a serious illness, there’s this constant fear: ‘Don’t get hurt. Don’t get sick,’” Alexander explained. “Because you can’t afford the consequences.”
Broader Implications of the ACA’s Uncertainty
The Tobiassens’ story is emblematic of a larger movement. With the expiration of subsidies, the ACA’s role as a safety net for middle-class families is being tested. For many, the program was a lifeline, but as costs climb, it’s becoming a liability. The KFF analysis underscores this shift, projecting a potential enrollment drop from over 22 million in 2025 to as few as 16.5 million in 2026. This decline could exacerbate healthcare disparities, leaving vulnerable populations exposed to financial hardship.
Despite their decision, the Tobiassens remain aware of the risks. Without insurance, a major health event could lead to crippling bills. “We’re taking a chance,” Ross admitted. “But we have no choice.” At 47, he believes his partial vision loss doesn’t significantly hinder his ability to work. Still, the looming threat of unforeseen expenses keeps him on edge. “I try not to think about it too much,” he said. “I just work.”
As the ACA’s future hangs in balance, the question lingers: How will these families adapt? For those like the Tobiassens, the answer is uncertainty. Their story is a microcosm of a national reckoning with healthcare affordability, where the once-reliable safety net is now a source of anxiety. The numbers tell a clear tale—enrollment is plummeting, and the ripple effects could be felt for years to come. Whether this trend signals a long-term shift or a temporary crisis remains to be seen, but one thing is certain: the financial burden of healthcare is reshaping lives, even as the program itself continues to evolve.
A Call for Policy Reevaluation
Experts warn that the ACA’s current trajectory may require urgent policy adjustments. The program’s success in expanding access during the pandemic was largely due to temporary subsidies, but their removal has left many scrambling. For families in Sugar Grove and beyond, the challenge is not just about paying premiums—it’s about balancing health needs with economic realities. The Tobiassens’ experience highlights the fragility of this balance, as even those with a history of manageable costs now face a daunting financial reckoning.
As the data from North Carolina and other states continues to emerge, the conversation around healthcare affordability is intensifying. The drop in enrollment is a stark reminder of the program’s limitations in the face of rising medical expenses. While the ACA remains a critical resource for millions, its ability to sustain coverage is now under scrutiny. For now, the Tobiassens and others like them are left navigating a landscape where health and financial stability are no longer guaranteed. Their story is a testament to the broader struggle, one that may shape the future of healthcare access in America.
“It’s not just about the numbers—it’s about the people behind them,” Alexander said. “These are real families, and their decisions are being driven by real costs.”
With the ACA’s subsidies set to expire, the question of whether the program can be restructured to meet ongoing needs becomes urgent. The Tobiassens’ journey—from relying on the ACA to canceling it—mirrors the experiences of countless others, underscoring a nationwide shift in how Americans perceive and afford healthcare. As the data reveals a steep decline in enrollment, the challenge is clear: how to ensure coverage remains accessible without compromising affordability. The answer may depend on whether policymakers can respond swiftly to the growing crisis.