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Inside America's health insurance 'death spiral'

The Affordable Care Act is facing what policy experts call its most serious affordability crisis since it began widely offering coverage more than a decade ago

Karen Scholl, a freelance writer in Ohio, has been buying her family's health insurance on the Affordable Care Act’s marketplace for a decade. This January, her monthly bill soared past $2,000 for the first time. 

“It's now $2,034.38," she said, detailing the cost for her, her husband, and their 22-year-old son, who is still in college. That new monthly premium is 25% higher than last year’s, and the steepest single-year increase yet. But it came on top of years of steady increases. “In 2023, it was $1,132.51,” Scholl said. “In 2024, $1,375.15. In 2025, $1,626.30.”

The price hikes have been so steep that at one point, the Scholls’ health insurance broker floated an unusual suggestion: If they were willing to sign a document stating they were Christian, they might qualify for a healthcare sharing ministry, which offers a lower-cost alternative to traditional insurance. 

“Our first reaction was a laugh,” Scholl said. "Like, oh, OK, no way. I mean, we're Jewish.” But then the new price tag kept flashing in her mind. “We turned to each other and said, ‘Well, could we really do it?’ I mean, ethically.” For a few minutes, she thought they might. 

“My grandparents escaped the Holocaust,” she said. “My grandfather’s mother and sister died in concentration camps. And I was going to say I was Christian just so I could afford healthcare? It made me kind of sick. And kind of angry.”

Louise Norris, a health policy analyst at healthinsurance.org, described the Scholls' experience as typical for families like theirs: self-employed and earning well above the threshold to receive insurance subsidies. 

"The overall average increase in underlying individual market premiums for people who weren't subsidy-eligible in 2025 was a little more than 25% nationwide,” Norris said. “So this family's experience tracks very similarly to the average.”

Among those who were eligible for the enhanced subsidies and then lost them, you find even starker cases, Norris said. She pointed to a hypothetical 63-year-old couple in West Virginia earning $85,000 — just above the subsidy threshold. In 2025, they could get the lowest-cost ACA Gold plan for $300 a month. In 2026, that same plan costs $4,562 a month.

The numbers can boggle the mind. And they paint a stark picture of how the Affordable Care Act,........

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