When Johana Scott logged into her health insurance account on Dec. 3, she expected to see her usual premium of about $200 a month. Instead, the screen showed $1,725 for the same plan.
“Which is not feasible, considering I make roughly around $1,200 a month,” said Scott, a Texas resident who was diagnosed with Stage 3 endometrial cancer in February. “I won’t even have money for groceries, not less alone my bills.”
Scott is one of more than 20 million Americans confronting a health care crisis with the expiration of enhanced tax credits under the Affordable Care Act on Jan. 1. The subsidies, which helped reduce monthly premiums for people who buy insurance through the A.C.A. marketplace, were allowed to lapse as Congress adjourned for the holidays without reaching agreement on an extension.
For Scott, the stakes could not be higher. Her cancer treatment requires immunotherapy sessions that cost between $20,000 and $45,000 each — more than her annual income for a single session. She said she would need the treatments weekly for the next two years.
“I’ve been crying since December because I don’t know what to do,” she told MS NOW. “If I don’t have my insurance, I am going to die this year.”
The loss of subsidies is hitting hardest among low-income Americans, small-business owners, farmers, freelancers and early retirees who do not yet qualify for Medicare but earn too much for Medicaid — groups that have long occupied a vulnerable middle ground in the American health care system.
Hannah White, who lives in North Carolina, said she was forced to make an impossible choice for her family. While her subsidy had been modest, she said her premium still jumped nearly 50 percent for 2026. She decided to absorb the increase herself, tightening her budget in other areas to avoid any disruption in her medical care.
But her husband chose to forgo insurance entirely because the family could not afford coverage for both of them.
“We are really gambling on there not being an emergency,” she said. “I think healthcare access in the U.S. is a crisis.”
Stacey Johnson, a retiree in Washington state living off of her savings, watched the monthly premium for her bronze plan triple from $500 to roughly $1,500 after her subsidies disappeared — a jump from $6,000 to $18,000 annually.
“That was manageable,” Johnson said of her previous costs. “That’s a three times jump, and it’s not sustainable. I will not be able to afford that long term.”
The enhanced subsidies were first enacted in 2021 as part of pandemic relief legislation and were extended in 2022. They significantly expanded eligibility and increased the amount of help available, leading to record enrollment in marketplace plans. But the subsidy extension was temporary, and efforts to make them permanent stalled amid partisan disagreements over health care policy and federal spending.
As Congress returns to session on Monday, some lawmakers are exploring bipartisan solutions to restore assistance for those most affected. But any legislative fix faces an uncertain path in a divided government, and millions of Americans cannot afford to wait.
Scott said she hopes she lives long enough for a solution.
“I know there’s so many other people, and it’s not like I’m this big, important person,” she told MS NOW. “But to my family and my friends, I am important, and I would like to live for, you know, for as long as I can.”
Maya Eaglin is a reporter for MS NOW.