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Some temporary tax credits for the Affordable Care Act expired last year, and KFF Health News released a plethora of statistics to paint a picture of how the expiration of those subsidies affected enrollment. Perhaps most compelling is that "People with incomes above 400% up to 500% FPL [federal poverty level], who represented just 3% of 2025 sign-ups, accounted for 27% of the drop in sign-ups from 2025 to 2026." 400% of the federal poverty level is "where eligibility for premium tax credits ends" (also known as a subsidy cliff). Another statistic is that even though "Plan sign-ups fell by over a million to 23.1 million people during the 2026 Open Enrollment Period," that drop does not count people who were automatically enrolled, but ultimately do not pay their premiums. One estimate is that the number of people who enrolled and will actually pay their premiums "could decline by between 17% and 26% in 2026 compared to the [2025] number." These statistics may be the result of another statistic that "Premium payments from enrollees increased by an average of 58%." Another statistic is that "From 2025 to 2026, the average deductible in the ACA Marketplaces has grown by over a thousand dollars per person, a 37% increase, from $2,759 to $3,786," which "marks the steepest increase ever in the average Marketplace deductible since the markets launched in 2014."

These numbers demonstrate that health insurance remains expensive for many Americans. If persistent, the rise in uninsured will likely affect more than just those who cannot afford health insurance. For example, emergency rooms might close if they become highly unprofitable if those who are are without health insurance visit in much greater numbers and do not pay.

KFF Health News highlighted the struggles that five patients in Connecticut encountered with regards to medical billing. In the first case, the patient was told that her procedure would cost her $5,000, which she prepaid. However, her insurer "covered only $15,000 worth of bariatric surgery, meaning she was responsible for any bills that exceeded that." Even worse, the health system that served her sued her for her balance.

It seems that health systems should give binding cost quotes for elective procedures so that patients are not surprised. That the patient's insurer only covered a certain dollar amount of bariatric surgery should have been known to both the health system and the insurer, and whatever out-of-pocket price was given to the patient should have factored in that limit. The breakdown in communication between the health system and the insurer does not seem like it should be the responsibility of the patient. Unfortunately, when patients try to get a firm price quote, medical groups will frequently refer the patient to the insurer and the insurer will refer the patient to medical group. Medical groups and insurer both have different pieces of the puzzle, and when the billing is done, the two parties are able to figure out how much the patient owes. Patients generally have less information than either the medical groups or the insurers, so a system that requires patients to figure out the cost themselves seems broken.

Last year's spending bill is expected to reduce Medicaid funding "by nearly $1 trillion over 10 years," and KFF Health News reported on Montana's challenges in sustaining Medicaid. They plan on enforcing the federal government's work mandate, which will curtain some enrollment. One idea is "to withhold a 3% Medicaid provider rate increase approved by the legislature and governor last year," but "Health organizations have pushed against the plan, saying that Montana's Medicaid payments already don't cover the cost of care and that health businesses can't afford wages that attract workers." The head of one nonprofit said that his organization "has more than 70 group-home beds it's been unable to fill, because it's down roughly 15% of its workforce." Another leader at a provider organization indicated that "low reimbursement rates can hurt their patients who need care elsewhere, as more healthcare providers decide they can't afford to accept Medicaid."

Reducing or stagnating provider reimbursement might seem like an easy option to stretch funding, but can lead to unintended consequences that make it difficult for patients to access care. At the same time, reducing benefits or coverage would also make it more difficult for patients to receive care.

With the rise in Affordable Care Act insurance premiums (and that "subsidies that help people purchase coverage shrank or vanished"), KFF Health News reported on the drop in enrollees who paid their premiums, citing one news source as saying that "roughly 21% of people using the federal ACA marketplace ... failed to pay their share of January premiums, which, if correct, is far higher than at the same time last year." In addition to rising premiums, "the average ACA plan deductible saw the steepest increase in history — growing by 37%, or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired." One consulting group "estimates that average ACA enrollment will end up being 17% to 26% lower this year than last."

With the effective premiums rising as much as they are, it is not surprising that many people choose to skip paying for insurance. Since healthier people might be more likely to forgo insurance, a drop like this can lead to higher premiums for the remaining enrollees, which could trigger spiraling prices. One consultant noted that these drops in enrollment "are real people with real consequences."

Non-profit organizations are supposed to provide community benefit in exchange for not having to pay taxes, and as such, hospitals frequently provide charity care for the indigent. However, KFF Health News paints a picture of how some such organizations in Minnesota try to minimize their obligation when law and regulations are vague. For one, some hospitals or health systems seem to make it difficult to find information online about charity care. For another, "some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000" -- which seems like a very low ceiling when an out-of-pocket maximum might be around $8,000 or a procedure might be "more than $19,000." Overall, the hospitals in the state spent about 0.8% off their operating budgets on charity care, about a third of the national average.

While the chief executive at one medical center is quick to point out that "many health insurers post billions in profits," the underlying cost of care is still a major issue. Diverting more and more of insurers' profits while not doing anything to address the cost of care seems to not be a winning strategy.