A small business owner in Thomaston, Maine, is contemplating dropping her health insurance due to escalating costs and the expiration of federal subsidies. Chloe Chalakani, who operates a handmade pasta business with her partner, faces significant financial pressure as she navigates the complexities of health insurance enrollment.
As the tourist season concludes and autumn sets in, Chalakani is reviewing her administrative tasks, including her health insurance options. Currently, she pays $460 monthly for the highest deductible plan available. “My premium is already $460 a month, and that is for the highest deductible plan that exists,” she explained. With enhanced tax credits set to expire in December 2023, and premium rates projected to rise, she has made the difficult decision to forgo coverage next year. “I don’t plan to get insurance next year. I’m just not going to do it — I’ll pay out of pocket.”
Chalakani’s choice reflects a broader concern among health policy experts about the stability of the health insurance market. The Affordable Care Act (ACA) relies on a diverse pool of insured individuals, including younger, healthier people who typically contribute more to the system than they consume. “You need people to be paying into the insurance system when they’re healthy so that they can take out when they’re sick,” remarked an expert in the field.
The potential for younger individuals to opt out of health insurance poses risks not only to their own health but also to the overall insurance system. If only those with higher health risks remain insured, the average cost of plans will rise significantly. “If you only have sick people buying health insurance plans, then the average cost of that plan is going to be very high,” the expert added.
Chalakani is among approximately 24 million Americans who obtain their insurance through the ACA. Her decision to go uninsured is echoed by other young entrepreneurs facing similar financial constraints. For instance, while Chalakani prepares to skip coverage, a 64-year-old individual in West Virginia, burdened by expensive medications, is more likely to maintain their insurance despite rising costs.
The implications of a growing uninsured population extend beyond individual health. Hospitals and healthcare providers may experience increased financial strain as more uninsured patients seek care. “If hospitals face a lot of financial strain from having a lot more uninsured patients coming through their doors, then they might start changing the services they offer,” the expert warned. Such changes could lead to the closure of essential services, including maternity wards, which would significantly impact community health.
As the federal government grapples with budgetary constraints, cuts to Medicaid under President Trump’s budget law are anticipated to exacerbate the situation, potentially increasing the number of uninsured individuals by millions. If Congress does not act swiftly to extend enhanced subsidies, many enrollees will likely encounter sticker shock when seeking coverage for 2026.
Chalakani acknowledges the risks of going without insurance, stating, “Should a catastrophe happen, I’ll probably say, ‘Wow, I should have had insurance.'” Yet, she feels constrained by her current financial situation. If lawmakers ultimately decide to extend the enhanced subsidies, she may reconsider her position on health insurance.
The future of health insurance in the United States hangs in the balance as small business owners like Chalakani navigate challenging economic landscapes. The choices they make not only affect their personal health but also the broader healthcare system, which relies on a balanced pool of insured individuals to function effectively.
