The health insurance crisis has finally entered the public consciousness. 200,000 to 350,000 Kentuckians are expected to lose their coverage as a result of the “One Big Beautiful Bill Act.” Commercial insurance carriers have already substantially increased premiums in response to market uncertainty.

Meanwhile, Congress failed to act before the end of the year to extend the expiring enhanced premium tax credits that help millions of Americans afford health insurance through the Marketplace, known as kynect in Kentucky. As a result, 2026 is poised to bring steep increases in health care costs, especially for individuals and families who buy coverage on their own. Although the House is expected to vote on extending the subsidies sometime in January, Congress has not committed to renewing them.

Estimates from KFF show that annual Marketplace premium payments will increase by an average of 114 percent, or more than double, from $888 in 2025 to nearly $1,904 in 2026, due to premium increases and the loss of subsidy support.

A striking example from KFF shows that a 60-year-old couple earning $85,000 per year could see their monthly premium rise from about $600 to $2,380. Combined with a 2026 family maximum out-of-pocket limit of $21,200, their annual health care costs could reach $49,760, or nearly 60 percent of their annual income.

The employer squeeze

The coverage emergency is not limited to Medicaid and the Marketplace. Employer-sponsored insurance is becoming increasingly unaffordable. Family premiums have increased by 26 percent over the last five years, and employers expect another 7 percent to 9 percent increase in 2026, the largest in nine years.

The Asclepius Initiative (TAI) is experiencing this firsthand. We are a small nonprofit with three full-time employees, and our group health insurance premiums increased 20 percent for 2026. Even with Marketplace premiums going up 27 percent, the monthly cost for one employee’s coverage is about half what it would be under our employer-sponsored plan. Financially, it now makes more sense to give staff members a stipend to buy coverage on the Marketplace.

Access is more than just a card.

To make matters worse, rising health care costs are only one piece of a larger problem. With support from the Commonwealth Fund, TAI interviewed 73 Kentuckians with varying coverage types across urban, rural, and Appalachian communities. We heard clearly that insurance alone does not guarantee access to care.

Participants told us they struggled with system complexity, distrust, and perceived bias based on gender, age, obesity, hearing loss, type of coverage (especially Medicaid), presumed drug-seeking behavior, and more. They waited months for appointments and traveled long distances for specialty care. And of course, there was also the cost element. As one person said, “You shouldn’t have to worry about money when you’re sick, but that’s what stressed me out more than anything else.”

Our 2024 statewide survey echoes these findings. Of the 1,001 adult Kentuckians surveyed, 55 percent with health insurance reported delaying or skipping medical care or medications because of the cost. Many described difficulty in obtaining or using their coverage. So, regardless of where people get their coverage (through work, the Marketplace, or public programs), there are numerous cost and non-cost barriers to care, not to mention the risk of losing coverage altogether.

A call for structural change

The battle over premium subsidies is more than a budget dispute in Washington. It represents a system failing to meet the needs of the population. Access to affordable coverage should not be at the whim of politicians, the decisions of employers, or some litmus test of worthiness.

At the Asclepius Initiative, our mission is to help Kentuckians understand that a better model is possible. The rising costs in 2026 aren’t an anomaly; they’re the inevitable result of a fragmented, unstable system. People suffer physically and emotionally, and even die unnecessarily, when they can’t get health care.

In the short term, we must extend the enhanced premium subsidies and reverse the Medicaid and Marketplace changes that will cause many Kentuckians to lose coverage and Kentucky hospitals to close. In the long term, we must support the adoption of a universal coverage program, so that life changes (and politicians) can’t take our health care away from us. It is time for the U.S. to join our high-income peer nations, where life expectancy is longer, and medical debt doesn’t exist.

We and our loved ones deserve better. If we want a better and healthier tomorrow, the time to act is now.

Susan G. Bornstein is an obstetrician-gynecologist.