Americans navigate 'wild West' of health insurance options after dropping Obamacare plans

When Stacy Cox, a self-employed photographer in Kanab, Utah, dropped her Obamacare health insurance plan this year, routine preventive care became a financial dilemma. Now she finds herself weighing $1,200 for a mammogram against the survival of her business.

"It's scary," the 49-year-old Cox told Reuters. "Every month we come to the table and we have a discussion. Is it time to close a business? Is it time to seek employment somewhere in the hopes of gaining health insurance?"

Cox is at high risk for breast cancer due to family history and has an autoimmune disease requiring regular medications.

She is among 3 million Americans who dropped out of the Affordable Care Act marketplace, created by President Barack Obama and often called Obamacare, due to sharp increases in premiums and deductibles at the beginning of 2026.

The plans, which offer subsidies based on income, covered 19.2 million people as of February, according to government data. Expiration of enhanced COVID-era premium tax credits at the beginning of the year contributed to sharp cost increases.

Cox is one of nearly a dozen Americans who told Reuters they shifted to skimpy, short-term health plans that provide less comprehensive coverage, or have joined health-sharing programs, where members pool monthly contributions to help pay each other's medical bills. Many Americans have opted to go without health insurance altogether, a situation that the ACA was originally meant to address.

Several hospital operators, including Universal Health Services, a Pennsylvania-based hospital system with more than 500 facilities, have flagged rising costs tied to treating uninsured patients. In July, its CEO said it seemed most patients who had dropped ACA coverage were now uninsured.

Enrollment data on short-term coverage remains limited.

A spokesperson for the U.S. Centers for Medicare & Medicaid Services said these plans, which are primarily designed to help fill a temporary coverage gap, such as when someone is transitioning from an employer-based plan, are one of several options available.

In the ACA marketplace, insurers have proposed a median premium increase of about 15% for 2027, according to health policy research group KFF, marking the second successive year of double-digit hikes.

Enrollment for ACA plans opens Nov. 1 and runs until Jan. 15. UnitedHealth, Elevance, Centene and Molina Healthcare offer Obamacare plans. Some insurers, like UnitedHealth, also offer short-term plans.

Turning to cheaper options

Ryan Shapiro, 56, from Frederick, Maryland, plans to wind down his photography business by year end and help his wife run her interior design business, in part due to the rising cost of healthcare.

Shapiro dropped his ACA coverage for this year because his monthly premium was set to more than double to over $1,000. He instead chose a short-term plan that costs roughly $600 a month and covers hospitalization and critical illnesses.

Under current federal rules, short-term plans are generally limited to three months, plus a one-month renewal. After CMS said last year it would stop enforcing that limit, several states allow longer coverage duration.

"It's half the cost of full-blown health insurance," Shapiro said. "It's a way for us to kind of minimize our expenses should a health crisis happen."

Skipping care

Several people interviewed said they had postponed or skipped preventive care, annual checkups and other treatment because of high premiums and deductibles, opting to pay out of pocket for urgent care when necessary.

"What do we do if one of us gets sick?" said Cox, who has skipped regular cancer screenings. "Do we just die? Because we sure can't afford to fight it, and that's a really scary place to be in."

High deductibles have been another pain point, forcing patients to pay thousands of dollars out of pocket for medical services before insurance coverage kicks in. Some also said their plans offered a narrow choice of doctors.

Some people have turned to health-sharing programs, often organized by religious groups, that typically do not provide consumer protections.

Cristin Connelly, a 53-year-old public relations consultant in Atlanta, joined Zion HealthShare in 2025 after dropping her ACA plan. She pays $480 a month for herself and her young adult children, which includes an annual preventive doctor's visit for each family member, one mammogram a year and a colonoscopy every other year, among other services.

Her plan has a minimum spend of $5,000 for submission, a de facto deductible Zion refers to as an initial unshareable amount that individual members must pay before medical expenses become eligible for the community sharing pool.

Zion HealthShare, which has more than 78,000 active members, has no religious requirements.

"My experience with insurance is it's such a hassle to get things paid. They deny claims all the time and then say they're only paying a portion of it," said Connelly. Her health-share experience "so far has been that when I ask for a self-pay rate for anything, it's much less."

She said she hopes to move off the health share in the long run.

Experts say health-sharing arrangements and other non-traditional products carry significant limitations.

Many states do not adequately police aggressive or deceptive marketing practices, said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms, leaving consumers vulnerable.

"There really and truly is a bit of a wild, wild West out there with respect to these products," Corlette said. "Some of them are legit, some of them not so legit, very much buyer beware!"

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