SUGAR GROVE, N.C. — Ross and Rebecca Tobiassen canceled their federally subsidized Affordable Care Act (ACA) health insurance in December 2025. The couple, who own a small auto shop in the North Carolina mountains, saw their monthly premiums rise from $130 to more than $550.

The Tobiassens had relied on ACA insurance since 2014, when they initially paid around $30 a month. "You actually felt like you were benefiting," Rebecca Tobiassen said. "It makes no sense. It's not worth it anymore."

Congress allowed enhanced tax credits for ACA plans to expire at the end of 2025. These expanded subsidies were established by the American Rescue Plan Act during the COVID pandemic, leading to ACA enrollment doubling to approximately 24 million. ACA premiums and deductibles increased starting in 2022 and spiked during the enrollment period for 2026 plans, according to data analyzed by KFF. Individual ACA sign-ups in North Carolina for 2026 were down 22% compared with the previous year, a decrease of more than 213,000 people. An early analysis from KFF, citing Wakely Consulting Group research, projected that ACA enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026.

Ross Tobiassen, 47, became mostly blind in his left eye in 2020 after experiencing corneal infections from metal shards. A specialist estimated cornea replacement surgery would cost up to $30,000 and require six months off work, leading him to choose a less expensive treatment to kill nerves in his eye instead. Ross Tobiassen, who works extended hours at the auto shop, said, "I try not to think about it too much. I just work." The Tobiassens' two teenage daughters continue to be covered by Medicaid.

Risha Gidwani, a healthcare policy researcher at the University of Colorado Anschutz School of Medicine, stated, "Plans are unaffordable, no matter how you cut it. It's just who is shouldering the unaffordability."