They’re uninsured after Obamacare became too costly. And they’re far from alone.

Sugar Grove, North Carolina—Ross and Rebecca Tobiassen, a couple in western North Carolina, have been grappling with rising healthcare costs year after year. They have been relying on the Affordable Care Act for federally subsidized health insurance since its inception in 2014. Despite the increasing costs, the couple continued to maintain their coverage, valuing the peace of mind it provided. However, in December, they made a difficult decision to cancel their insurance when they discovered that their monthly premiums would skyrocket from $130 to over $550.

Rebecca expressed her frustration, stating, “It makes no sense. It’s not worth it anymore.” The Tobiassens own and operate a small auto shop near Appalachian State University in the North Carolina mountains. Rebecca, concerned about her husband Ross’s safety as a mechanic, recounted incidents where he faced serious injuries on the job, such as losing partial vision in one eye due to metal shards and infection.

The couple’s decision to cancel their ACA coverage was influenced by the expiration of enhanced tax credits that helped subsidize insurance plans, a change brought about by Congress at the end of 2025. This shift has impacted millions of enrollees, leading to a decline in ACA enrollment. The Biden administration’s American Rescue Plan Act had initially introduced expanded subsidies to reduce monthly premiums for families, resulting in a surge of new signups and doubling ACA enrollment to approximately 24 million.

However, the Centers for Medicare & Medicaid Services are expected to report a drop in ACA enrollment, with estimates indicating a decrease from over 22 million at the end of 2025 to as low as 16.5 million in 2026. North Carolina witnessed a significant 22% decline in individual ACA signups for 2026, surpassing other states in terms of reduced enrollment numbers.

Rebecca expressed her disappointment with the increased prices, feeling that the federal government disregards families like hers. Despite their concerns about being uninsured, the Tobiassens have chosen to forego coverage, exploring alternative options through a faith-based healthcare organization before ultimately deciding to go without insurance. They have set aside some savings for emergencies but acknowledge that they may have to rely on credit cards or family support if faced with a medical crisis.

Katie Alexander, who works with Pisgah Legal Services, a nonprofit aiding low-income individuals in securing health insurance, highlighted the challenges faced by North Carolina residents in navigating the changing healthcare landscape. She noted that nearly 100 clients opted to drop their insurance this year, while others opted for cheaper ACA plans with reduced coverage, reflecting the financial strain many individuals are experiencing.

The Tobiassens’ experience underscores the broader issue of affordability and access to healthcare, particularly for those who fall through the gaps in the system. As premiums and deductibles continue to rise, many families are finding it increasingly challenging to afford adequate coverage. The implications of these changes extend beyond individual households, impacting the overall risk pool and potentially leading to higher premiums for those who remain insured.

In light of these challenges, it is essential to address the underlying issues contributing to the unaffordability of healthcare and explore sustainable solutions to ensure access to quality care for all individuals. The Tobiassens’ story serves as a poignant reminder of the complexities and barriers faced by many Americans in navigating the healthcare system.