Jacksonites turn to 'Wild West' of insurance as health care subsidies expire

JACKSON — When Margie Lynch, 58, recently learned that her monthly health insurance premium was set to more than double, she began looking for other options.

Like many self-employed people in Teton County, Lynch has for years bought coverage through the Health Insurance Marketplace authorized by the Affordable Care Act, or Obamacare. But because of skyrocketing premiums fueled by congressional inaction on expiring subsidies, she began investigating plans for individuals elsewhere.

Such non-Marketplace plans often offer fewer protections for individuals and can refuse to cover care. The lack of lawfully required protections for such options could put consumers at risk, policy experts warn.

"It is a Wild West," said Jennifer Sullivan, the director of health coverage access at the Center on Budget and Policy Priorities in Washington, D.C. "It is not a regulated market the way the Marketplace is. There are not as many guarantees, and there are far fewer consumer protections."

One plan Lynch eventually found said it would not pay for care if she got hurt while doing "extreme sports." When she followed up, Lynch learned that injuries she sustained skiing and mountain biking would be covered — but those that happened while rock climbing wouldn't.

"Somebody who's never been outside wrote that," said Sam Strauss, a resident who also has struggled with skyrocketing health care premiums.

"The devil's in the details," Lynch said. "You run the risk that something happens and they say, 'Sorry, not covered.'"

Still, despite the risk, Lynch believed the plan was better than paying $1,585 a month for a bronze Obamacare plan. With the alternate option, she estimated she would save around $1,000 every month.

"It's a little bit of a situation of rolling the dice," Lynch said. "If I decide at the end of the year that it doesn't work, I will go back on Marketplace ... in the meantime, I'll have saved $10,000, if not more."

Lynch is among several residents, across age groups, grappling with what to do as their Marketplace premiums rise. Some have decided to bite the bullet, potentially forking out what could have been savings to remain securely insured. Others are looking elsewhere, including to non-insurance cost sharing programs that pool money from members and reimburse participants — though not always — when they need health care coverage.

The skyrocketing premiums stem from the looming expiration of subsidies passed by Congress when the pandemic hit and set to elapse at the end of this year. Those additional subsidies made Obamacare plans cheaper for many Americans. Though Democrats have made pushes to extend the subsidies, joined by a handful of moderate Republicans in the House, most GOP lawmakers have so far shot down those efforts.

"It's not going to happen by the end of the year. There's not going to be an extension. However, there could be an extension in January," said Nicole Rapfogel, a senior policy analyst at the Center for Budget and Policy Priorities. "It's still possible, but the longer it takes, the more uncertainty people are facing."

The subsidies made plans cheaper across income brackets. However, people making more than 400% of the federal poverty level — $62,600 in 2025 — are set to be hit the hardest.

"Those folks will have a cliff," Sullivan said. "If you are making more than 400% of the federal poverty level, then you don't get any assistance whatsoever."

All three Wyoming congressional representatives acknowledged constituents' struggles with health care access. They cast general blame on Obamacare.

"Obamacare has failed families across Wyoming," U.S. Sen. John Barrasso, a former doctor, said in a statement. "Instead of working with Republicans to make health care more affordable for all Americans, Democrats would rather use more taxpayer dollars to bailout Obamacare and hide its failures."

Looking elsewhere

When the Affordable Care Act passed in 2010, it changed the way that health insurance could be offered to individuals who were looking to buy their own plans, independent of an employer.

By law, health insurance companies were no longer allowed to exclude people for pre-existing conditions or charge them more for demographic factors, like charging women more than men. Though some pre-Obamacare plans that exclude coverage were grandfathered in and still exist, there are few left, according to Michelle Long, a senior policy manager at KFF, a health research, policy and news organization.

But some options do not have to follow the Affordable Care Act's rules. Those include so-called short-term or limited-duration health plans, like the one Lynch is considering, that are meant to bridge time periods in which people may not have coverage.

Under the Biden administration, short-term health plans were limited to offering coverage for no longer than four months, Long said. Lynch said, however, that her plan lasted for 364 days. The Trump administration recently announced that it would stop prioritizing enforcement of the Biden-era regulation, Long said.

"Under the previous Trump administration, people were able to extend those for a much longer period of time," Rapfogel said. "The Trump administration has indicated they're not interested in regulating these non-ACA-compliant plans, to a great degree."

Long warned that non-Marketplace plans could refuse to cover treatments, and often are unclear about what they cover upon signing up.

"You don't get virtually [any] of those protections that you get with an ACA plan," Long said.

Others in the region may turn to crowdfunding options. Joey Sackett, a 31-year-old photographer, was on a Marketplace plan last year. Because of an expected increase in his premium, though, he likely will turn to a company called CrowdHealth.

CrowdHealth, on its website, says it does not offer health insurance. Instead, the company asks its members to contribute money toward reimbursing other participants' health expenses.

Sackett, who has bought another policy to protect him in case of an outdoor accident, said the cheaper option might not be a good idea for people who had pre-existing conditions or who frequently sought health care. But for him, it seemed like an idea worth exploring.

Long said CrowdHealth's model was similar to health care sharing ministries. Those ministries, which do not offer health insurance, usually pool money from a community of Christians and reimburse people for care after the fact.

"I've read stories of people who are happy with their health sharing plan, because they only have to pay 50 bucks a month for it," Long said. "I've heard of people needing basic medical care and saying that it was covered by the health sharing ministry."

But that reimbursement is not guaranteed, Long said, adding that sharing ministries are the least regulated option. They could deny claims for accidents — like those incurred while skiing — or run out of money.

"If you're considering a health sharing ministry, really read all of the details," Long said. "Understand what's in the fine print."

A religious-affiliated ministry also could restrict coverage for services that do not align with its values. It could ask participants not to drink alcohol, or even not enroll people who are gay or lesbian, Long said.

"Most of them don't cover any contraception," Long said. "None of them will cover abortion."

The News&Guide spoke to one Teton Valley, Idaho, resident who was enrolling in a health care sharing ministry and who knew other residents who had done the same.

"We just want consumers to know what they're getting into," said Jeff Rude, the insurance commissioner of the Wyoming Department of Insurance. "They aren't regulated, and there's no one to back up payments not made."

CrowdHealth does not appear to have a religious affiliation. Rude added that the department was going to look into the company's offering.

Biting the bullet

Some young people in Teton County are biting the bullet, electing to enroll in the ACA Marketplace despite skyrocketing premiums.

Strauss, a 29-year-old wildlife guide, said she would choose a Marketplace bronze plan for 2026. In order to stay under 400% of the federal poverty level, and thus still qualify for some relief on her premiums, she already has started declining trips for the upcoming year.

"I am hoping by saying no to work that I'm going to be able to stay below that number," Strauss said. "But it's disincentivizing me to be doing a job that I love and am passionate about."

Garrett LeRoy, a 28-year-old freelance video producer, is opting to pay $787 a month in 2026 for a Marketplace bronze plan. But at least once, he considered becoming an electrician to get access to health care.

"It's the Wild West in that it's forcing everyone to evaluate options that, a year ago, they hadn't even considered," LeRoy said.