DETROIT – For Tim Abbas, the Affordable Care Act insurance plan has been more than just coverage — it’s been a lifeline. When his brain tumor progressed to grade four, the plan allowed him to access a crucial clinical trial at an out-of-state hospital.
But now, as enhanced premium tax credits are set to expire on December 31, the Abbas family faces a difficult choice.
“We can’t afford the insurance anymore that lets us go there,” said Gina Abbas, Tim’s wife. “Life-saving care for my husband is top of mind, and it’s really, really hard.”
The impending expiration of enhanced premium tax credits threatens to disrupt health care access for approximately half a million Michigan residents who rely on the ACA marketplace for health insurance.
According to the Kaiser Family Foundation, premiums would more than double for subsidized enrollees — from an average of $888 in 2025 to $1,904 in 2026.
Tim, a former schoolteacher, will now switch to his wife’s insurance plan, but this comes with its own challenges — the hospital running his clinical trial is out of network, leading to higher costs the family cannot afford.
“We are not here for a free ride,” Gina said. “The ACA plan was there for families like ours that needed affordable options facing a health crisis.”
Ashley McVay, who has stage four colon cancer, expressed concern about the premium increases.
“Nobody really can afford any jump in anything,” she said. “I believe it needs to stay what it was.”
McVay has to switch her health insurance provider in 2026 because Molina Healthcare is exiting the ACA marketplace.
“I was only paying $22 a month. They said it was going to be canceled, and I had to find another plan, and that one is $80 a month,” she said.
Mark Fendrick, MD, of the University of Michigan, warns of potentially severe consequences without the subsidies.
“Since the government is no longer paying a proportion of the premiums, people will either pay higher premiums and potentially forgo other things like rent and utilities, or — and this is what worries me — they won’t pay the premiums and they’ll fall back into being uninsured,” he said.
Fendrick noted that while the original ACA exchanges will remain intact for those with the lowest incomes, individuals who received enhanced subsidies during the COVID-19 pandemic will be most negatively impacted.
He also said the rise in premiums could impact the commercial insurance market.
“As healthy people perhaps fall out of the exchanges, we’ll see more and more people who have higher medical needs, which will drive utilization and costs. And I wouldn’t be surprised to see if premiums actually rose in the commercial marketplace — that insurance you get from your employer — as well as some impact on the Medicare program,” Fendrick said.
For Tim and others who have relied on the tax credits, they’re balancing their own health and the financial health of their families.
“(Tim) said, ‘What if I just stop getting care?’ He eventually will be on Medicare, but that’s not until August. He’s like, ‘I’ll just wait until August.’ (Tim) can’t do that. He won’t be alive,” Gina said.
She said other people in their support groups and in the cancer community are all having to make really difficult decisions.
“Sometimes it’s a choice between being able to pay your mortgage or keep your loved one alive,” Gina said.
Fendrick encourages people to have some type of health insurance coverage.
He recommends the Plan Finder website provided by the federal government to help people find private health plans available outside the Health Insurance Marketplace.
“Compared to being uninsured, if something catastrophic were to occur, it’s always better to have some type of insurance plan than none at all,” Fendrick said.