WASHINGTON — Millions of Americans are getting ready to lose health insurance coverage in 2026 as the increased Affordable Care Act marketplace subsidies end, causing many households to consider going without coverage and look for alternative ways to access medical care.
An estimated 4.8 million people could lose their insurance after Congress refused to extend the enhanced premium tax credits that helped reduce monthly marketplace costs. For some consumers, even small increases in premiums make coverage unaffordable.
That is the situation facing Robert and Emily Sory of Thompson’s Station, Tenn., who plan to go without insurance next year. Robert was covered by a fully subsidized marketplace plan but discovered that the least expensive bronze plan for 2026 would cost at least $70 a month.
“When you do not have any income coming in, it does not matter how cheap it is,” Robert told Nashville Public Radio. “It is not affordable.”
Both lost their jobs in November and are preparing to handle healthcare costs without insurance. Emily said paying out of pocket for her prescriptions cost $184 in a single month. The couple has negotiated lower cash-pay rates with their psychiatrist and plans to use payment plans or emergency care if other health issues come up.
Healthcare providers are preparing for a rise in uninsured patients. Federally Qualified Health Centers, which offer care on a sliding fee scale, are expected to take on a bigger role. Many also run on-site pharmacies and partner with organizations like Dispensary of Hope, which supplies donated medications for uninsured patients with chronic conditions.
The impact could be most significant in the 10 states that haven't expanded Medicaid, including Tennessee, where low-income adults might earn too much to qualify for Medicaid but too little to afford private insurance.
As subsidies end, clinics, pharmacies, and hospitals prepare for higher uninsured rates and increased demand for affordable care options in 2026.
