When Kassidy Hooter learned in December how much her health insurance costs were going to rise this year, she went into panic mode.

The Shreveport, Louisiana, resident and mother of three knew she urgently needed care — Hooter is in the final trimester of a high-risk pregnancy. But the family could no longer afford their Affordable Care Act plan coverage now that a federal tax subsidy was lapsing on Dec. 31, 2025, meaning they would face thousands of dollars in additional out-of-pocket costs.

"We heavily considered that it might just be cheaper to give birth at home," Hooter, 24, told CBS News. "Just because that's an insane amount of debt to take on."

In the end, Hooter decided to forgo insurance altogether.

A local medical center offered three months of financial aid that will carry her through her due date in February and into late March. After that, she will have to bear any medical expenses on her own. Her plan now is to get her newborn on Medicaid, a government health plan for low-income Americans, as quickly as possible.

"I'm just hoping for the best," she told CBS News.

Health insurance as "luxury"

Since its introduction in 2010, the ACA has been instrumental in cutting the share of uninsured Americans from approximately 15% to 8%, according to Nima Sheth, vice president of health justice at the National Partnership for Women and Families, a nonprofit advocacy group.

However, the number of people without health insurance is likely to surge if Congress fails to come up with a solution for the 22 million Americans who received an ACA tax credit, experts warn. The number of uninsured will rise by an average of 3.8 million each year from 2026 to 2034 without an extension of the credits, the Congressional Budget Office estimated in 2024.

Americans in most states have until Jan. 15 to enroll in an ACA marketplace plan, according to healthinsurance.org.

Without the tax credits, premiums for ACA enrollees who previously relied on the subsidies will increase by an average of 114%, estimates KFF, a nonprofit provider of health policy news and research.

"What we're seeing here is a policy choice — is, in effect, turning insurance into a luxury item and medical debt into the default," Michelle Sternthal, interim senior director of policy and strategy at health care advocacy group Community Catalyst, told CBS News.

The House of Representatives on Thursday approved a three-year extension of the expired ACA tax credits. The legislation faces an uphill climb in the Republican-led Senate, although lawmakers think it could provide a starting point for a compromise that would keep the credits alive in some form.

"It's weighing extraordinarily heavily on me"

Plantation, Florida, resident Stacy Kanas, whose family also received an ACA tax credit, is now considering going without health insurance after realizing that her monthly premium to cover her and her husband would rise to $2,500 — more than double what she was paying last year to cover both of them plus her 20-year-old daughter.

"It's weighing extraordinarily heavily on me," Kanas, 59, told CBS News. "My husband had a major surgery about five years ago, and we don't want to be uninsured."

Although in decent health, the small business owner worries about what could happen if someone in her family falls seriously ill. "You're one catastrophic event away from perhaps having a financial disaster," she said.

Even people who keep their ACA coverage could end up skipping out on care to avoid out-of-pocket expenses, experts said.

"If you're underinsured and you have high deductibles, the coverage that you're getting is designed to dissuade getting care, including preventative care, so you're going to delay your care until there are emergencies," Sternthal said.

Robert Myers, a consultant based outside of St. Louis, Missouri, was on a silver ACA plan last year, but switched to a bronze plan after learning his premiums would rise to $400 a month, up from $17 in 2025.

Under his new plan, the 31-year-old does not have a monthly premium. However, Myers could owe much more in out-of-pocket costs due to $80 co-pays and an $8,000 deductible. As a result, he's planning on scaling back on doctor's visits, a trend experts say ends up driving more people to the emergency room for care.

"They'll kind of go to the ER and get what they need fixed with a band aid, and then not get long-term care," Sheth said.

This can have wider ripple effects because an increase in uncompensated hospital care can drive up costs for other patients, as facilities seek to recoup the costs, according to Sternthal, who supports an extension of the ACA tax credits.

"Every delay locks families into decisions that harm their health and their financial stability, but then also reverberates out into the business community, the local community," she said.

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