Impact of Expiring ACA Subsidies on Health Coverage
The expiration of enhanced subsidies for Affordable Care Act (ACA) marketplace plans this month is projected to result in approximately 4.8 million individuals losing health insurance coverage. This change has led many individuals to seek alternative solutions for managing their medical needs.
Case Study: The Sory Family's Healthcare Planning
Robert and Emily Sory, who operate an animal sanctuary outside Nashville, are among those facing a lack of health insurance starting in 2026. Robert previously had an ACA marketplace plan with zero-dollar monthly premiums due to subsidies. For 2026, a basic "Bronze" plan is quoted at a minimum of $70 per month, which Robert has deemed unaffordable given his current income status. Emily also lost her job-based insurance in November.
The Sorys are developing strategies to manage healthcare costs without insurance. This includes negotiating direct payment rates with their psychiatrist—$125 per visit for quarterly appointments to maintain prescriptions—and considering emergency room visits for acute issues, with an expectation of subsequent billing and repayment plans. Emily Sory has accumulated medical debt due to prior health conditions requiring doctor visits.
Challenges for Healthcare Providers and Uninsured Individuals
Hospitals and clinics anticipate an increase in patients without insurance. Federally Qualified Health Centers (FQHCs), which receive federal funding, offer services on a sliding scale based on a patient's ability to pay. Katina Beard, CEO of Matthew Walker Comprehensive Health Center in Nashville, highlighted that while patients would still receive a bill, it would reflect their financial capacity.
Many FQHCs also operate on-site pharmacies, some of which partner with the Dispensary of Hope, a Nashville-based nonprofit. This organization distributes donated medications from pharmaceutical companies to 277 sites across 38 states. These medications are provided free of charge to uninsured individuals with annual incomes below 300% of the federal poverty limit, primarily covering chronic conditions such as hypertension, diabetes, and mental health issues. Scott Cornwell, CEO of Dispensary of Hope, anticipates increased demand and is engaging pharmaceutical manufacturers for additional support.
Medicaid Expansion and State-Level Disparities
The financial strain on hospitals may intensify, particularly in the ten states that have not expanded Medicaid under the ACA. These states include Tennessee, where the Sorys reside. Non-expansion of Medicaid, an optional ACA provision predominantly funded by federal dollars, contributes to a "Medicaid gap" where working, low-income adults may lack affordable insurance options. Projections from the Urban Institute indicate that uninsured rates could rise by as much as 65% in Mississippi and 50% in South Carolina due to this gap.
Emily Sory, who has prior experience in healthcare staffing and has a mother working as a nurse, has acknowledged the systemic financial challenges within healthcare. She notes her inability to pay medical bills due to financial constraints.