If affordability feels like a crisis, it’s because it is.
Olivia Troye at Olivia of Troye:
Something big is about to hit American families on January 1, and almost no one sees the full picture. As a predominantly national security expert, why do I care so much about this? Because I’ve spent my career connecting the dots to keep America safe, and this is one of those dots. While headlines focus on affordability struggles and economic anxiety, the real crisis is happening in the shadows: health-care costs are about to surge across every system at once. Affordable Care Act (ACA) premiums are jumping by double digits, millions pushed off Medicaid remain without options, and employer plans face their biggest cost increase in more than a decade. Meanwhile, Speaker Mike Johnson is pushing to strip IVF coverage from military families. This is why people feel like they’re living in a recession: America keeps shifting more and more of the burden onto families already stretched to the breaking point. This is the squeeze. And January is when it becomes visible. Combined, this isn’t just health policy, but a slow-motion, government-engineered pay cut for working families, reflected in your January bill. Much of this squeeze was baked into the health-care package Republicans passed earlier this year. The one Trump branded his "big beautiful bill," even as it raised costs and weakened protections for millions of families.
What’s actually happening in the numbers
ACA Marketplaces
Insurers are increasing ACA Marketplace rates by an average of 26% for 2026. In states using HealthCare.gov, the benchmark silver premium is rising around 30%. In state-run marketplaces, premiums rise about 17%. Most people haven’t felt these hikes yet because enhanced premium tax credits expire Dec. 31, 2025. Without those enhanced subsidies, what people actually pay more than doubles. KFF, an independent source for health policy research, polling, and news, estimates average net premiums jump 114%, from $888 to $1,904 a year! Trump-era rule changes have also led to higher required contributions from families if enhancements lapse, further increasing household costs.
Medicaid Losses
During the pandemic, states paused most Medicaid disenrollments. That ended in 2023. Since the "unwinding," at least 25 million people have lost Medicaid coverage, about 31% of completed renewals. KFF’s national analysis shows about two-thirds of disenrollments have been procedural: paperwork, bad addresses, confusing forms–not ineligibility. I warned last summer that Medicaid would be hit with a thousand cuts–legislative, administrative, and ideological. Now it’s here. Millions have lost coverage not because they did anything wrong, but because the system was quietly designed to make them fall through the cracks.
Employer Insurance
The average family premium rose to $26,993 in 2025, up 6% from the year before. Workers now pay an average of $6,850 out of pocket. Employers project 2026 health benefit costs will rise 6.5%, and nearly 9% without aggressive cost containment, the largest increase in 15 years. These are different systems, but they’re all tightening at once, hitting the same families from different angles. This is where "silent recession" becomes daily life:
A parent opens their ACA renewal and finds they owe an extra $80–$150/month. A worker sees their “raise” erased by a higher premium and deductible. A family kicked off Medicaid only discovers it once someone gets sick.
Meanwhile, medical debt is exploding:
20 million adults in the U.S. carry significant medical debt (>$250), totaling at least $220 billion.
36% of households report having some form of medical debt (Read the stats on the NIH website while you still can, before this administration buries the data.)
30 million Americans borrowed money for medical care in 2024, adding $74 billion in loans and credit card balances.
When premiums and deductibles rise while subsidies vanish, predictable consequences follow:
Prescriptions skipped
Visits delayed
Debt accumulated
Systems blamed for "individual choices"
It’s evidence of a broken structure where families are saddled with rising costs they can’t absorb, while the health-care system shifts the burden away from those with the most power.
Republicans are playing games with health care premiums that will cause a big sticker shock for millions of Americans come January 1st.