Rising Health Costs and Federal Policy Shifts Put Pressure on U.S. Families

Medicaid work requirements and the end of ACA subsidies are tightening budgets, and one Pennsylvania caregiver saw her premium climb from $400 to $865 a month.

Economic snapshots: Persistent inflation and a sluggish job market have pushed the economy to the center of the election conversation. As voters head to the polls, USA TODAY Money reporters traveled across the country to see how Americans are handling financial strain, from sudden layoffs and long job searches to the everyday challenge of making ends meet. This is the third story in a six-part series.

Lynn Weidner expected her health insurance costs to rise after enhanced Affordable Care Act subsidies expired.

What she did not expect was that a pay raise from a Pennsylvania caregiver program would erase her eligibility for aid altogether. The extra income pushed her above the ACA threshold for subsidies, which are unavailable to people earning more than four times the federal poverty level, or $63,840 for an individual.

As a result, her monthly Obamacare premium more than doubled, rising from $400 to $865.

“I got a raise of $2 an hour,” Weidner said. “So I lost every bit of assistance I could get.”

Weidner is among millions of Americans trying to keep up with the cost of health insurance, medical care and daily necessities. Fewer than half of adults say they can afford health care, medical appointments and prescriptions, according to a June survey from West Health-Gallup.

Gas, groceries and other essentials have also become more expensive, while consumer confidence sits at a 12-year low. A KFF poll found that two-thirds of people support “Medicare for All,” the idea of extending government-funded health insurance to everyone.

For consumers balancing rent, utility bills and other basics, medical care is often postponed or reduced to preserve cash.

Weidner cut back her weekly therapy visits to every other week because she could not afford the copay. Her family also negotiated a lower monthly internet bill.

When a backup caregiver took another job, Weidner increased her workload to 80 hours a week as a full-time caregiver for her long-term partner, who has cerebral palsy. Under a Medicaid waiver, a Pennsylvania program pays family members or home-care workers who provide in-home services to eligible patients. She is also an unpaid caregiver for her mother, who has early-stage Alzheimer’s disease, and for a 2-year-old niece.

Weidner, her partner and her mother live in an apartment in a suburb of Allentown, Pennsylvania. The unit is not designed for people with disabilities, but they remain there because the $1,600 monthly rent is manageable.

Even with insurance, keeping up with medical bills remains difficult. Each year, she must satisfy a new deductible before coverage begins, so bills build up until that point. She pays $210 a month, but it is never enough to cover everything she owes.

“I always have rolling medical debt, even with insurance,” Weidner said. “By the end of the year, I’m almost paid off but it starts all over again.”

Prices Keep Rising

Health policy analysts say federal changes could put even more pressure on families already struggling to balance their budgets.

More than 3 million people dropped Affordable Care Act coverage this year. Many faced much higher monthly premiums after the enhanced subsidies created during the COVID-19 pandemic expired. Enrollment experts said some people likely left because they could no longer afford coverage, while others may have gained insurance through work.

A federal report released in June said 19.2 million people were enrolled in an ACA plan as of February 2026, down from 23.1 million people who had signed up by January 2026. Trump administration officials also cut off subsidies for about 760,000 enrollees they said were fraudulent, improper or phantom sign-ups arranged by rogue insurance brokers.

Most working-age Americans get insurance through their jobs, but those plans are becoming more expensive as well. According to KFF’s annual employer health benefits report, the average family plan offered by an employer now costs more than $28,000.

Even employer coverage can strain household finances. Houston resident Jennifer Jobe, a public school district employee, said she still owes thousands of dollars after her battle with colon cancer.

Workers are also paying more out of each paycheck for job-based coverage. In 2026, employee deductions for health insurance rose 9%, while average wages increased only 3.7%, according to KFF. AON projects employer health insurance costs will rise another 9.5% in 2027, the fastest pace in two decades.

Millions of Americans on Medicaid, the state-federal program for low-income families and people with disabilities, are expected to lose coverage when stricter eligibility rules take effect. Enrollees will be required to work at least 80 hours a month, attend school, complete job training or volunteer to keep their government-funded coverage.

About 1 in 4 U.S. adults said they or a family member had medical debt as of December 2025, according to an Urban Institute survey. More than 1 in 3 adults without health insurance reported medical debt.

“There are gaps in the extent to which health insurance is protecting people from out-of-pocket costs that they can’t pay,” said Michael Karpman, a principal research associate at the Urban Institute. “And there’s a serious concern that this could get worse over time. Health care costs continue rising and these federal cuts to Medicaid and (ACA) marketplace coverage begin to take effect over the next several years.”

Earlier Urban Institute research projected that 3 million to 7 million people could lose Medicaid coverage because of work requirements, while another 2 million to 3.1 million could be dropped after more frequent eligibility checks.

Other economists believe the losses may be smaller. University of Chicago economist Robert Kaestner estimated that about 2 million people could lose coverage nationwide because of Medicaid work rules and ACA subsidy cuts.

Kaestner pointed to the surge in Medicaid enrollment during the COVID-19 era as evidence that people are capable of finding coverage elsewhere. During the pandemic, states paused eligibility checks in exchange for federal funding. When checks resumed and ineligible enrollees were removed in a process known as unwinding, millions lost Medicaid coverage.

Even so, Kaestner said Census data released after the unwinding showed the uninsured rate held steady, suggesting there was “no evidence this increased the rate of uninsured.”

He added that consumers are still likely feeling the combined pressure of higher health costs, inflation and a more expensive cost of living. Inflation outpaced wages for three straight months through September 2026, leaving paychecks with less buying power.

“Anyone with a memory of six or seven years is saying, ‘Wow. The cost of everything has gone up,'” said Kaestner, a research professor at the University of Chicago’s Harris School of Public Policy. “Prices stay up. They don’t come down.”

A Teacher Chooses Health Over the Bills

Jobe was diagnosed with colon cancer five years ago.

The 43-year-old middle school teacher underwent surgery, chemotherapy, genetic testing and regular scans before being declared cancer-free. Recent scans have shown no sign of cancer, and she no longer takes maintenance medication.

Although she has dependable insurance, her plan includes a high deductible and an annual out-of-pocket maximum of $8,000. That is the most she must pay herself before insurance covers the rest. One chemotherapy treatment alone easily exceeded that limit.

She got help along the way. A GoFundMe campaign created on her behalf eased some of the financial strain during her first year of treatment. A patient assistance program arranged through her medical provider, M.D. Anderson, paid about $4,000 for her medication, leaving her with another $4,000 to cover.

Even after finishing chemotherapy and learning that she was cancer-free, the bills kept arriving.

She still owes about $4,000, and most of that debt has been sent to collections.

Jobe says she is focusing on her health rather than the financial fallout that often follows a cancer diagnosis. She understands why millions of Americans worry about medical debt, but she believes staying positive is essential.

“I’m not stressing medical bills,” Jobe said. “I send $50 a month and if it gets paid, it gets paid. If it doesn’t, it doesn’t. Who has an extra $8,000 laying around to pay bills every year?”