THIS TIME ON CODE WACK!
Millions of Americans are expected to forgo buying health insurance starting in 2026 as the cost of their coverage soars. Others who currently qualify for Medicaid may find the rules have changed and they are no longer eligible. What can people do when they need care but can’t afford it? And why are young people especially at risk?
To find out, we spoke with Rachel Madley, director of policy and advocacy at the Center for Health and Democracy. She previously served as health policy advisor to Congresswoman Pramila Jayapal and worked in the Office of Legislative Affairs at the U.S. Food and Drug Administration. Having struggled personally with a chronic medical condition, Rachel shares her firsthand experience staying alive despite America’s cruel healthcare system. This is the second episode of a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
So what can people do if they lose coverage like Medicaid? Are there any other options besides paying out of pocket every time they need care?
Madley: “That’s a great question. So in terms of getting coverage, if you lose Medicaid, it depends why you lost the coverage.
“So in the recent Medicaid cuts bill that was passed, if you lose coverage on Medicaid because you don’t meet the work requirements, unfortunately you are not eligible for subsidies for the Affordable Care Act plans. And so you cannot buy through that.
“You could pay the full price for those individual plans’ premiums. But the cruel thing is if you are on Medicaid to begin with, you are not going to be able to pay those premiums out of pocket. You may qualify for the ACA subsidies if you lose Medicaid due to something else because we’re possibly going to see states restricting their Medicaid eligibility, even if it was more generous than the federal level to make up for the funding gaps that they have.
“So definitely still try to apply for ACA marketplace coverage and just see what happens, but be prepared that you may not be able to get that.”
So, say you apply for ACA marketplace coverage and you aren’t eligible or you can’t afford it, what then?
Madley: “If you can’t get coverage there, there are not many other options for health insurance available to you. The current administration recently started to relax the rules against short-term health plans, which are often referred to as junk health plans. These are plans that upfront they have much lower premiums, but they are not required to abide by the coverage rules in the ACA. So that means they can do things like not cover certain essential health benefits like childbirth for example. But often it’s not clear when you sign up for the plan that that’s the type of plan it is. And so people may see increasing advertisements for those plans.
“If you lose Medicaid and you can’t get any other type of coverage, there are … Federally Qualified Health Centers in your area that often have sliding scales based on income. So you will go in, let them know how much you make, and the fee will be based on income. Usually they’re pretty affordable and Federally Qualified Health Centers can offer a lot of different services. It’s not just primary care. So definitely look there.
“And then there are charitable clinics. It depends on the area that you live in, but there are a lot of free or no-cost clinics around. Again, it is income based, so they may have a sliding scale as well, but those are options that you can seek out.
“It’s not gonna be long-term, steady healthcare like you may have had when you had insurance and you see the same doctor and you have your specialists and things like that, but it will keep you alive and hopefully keep you healthy for the time that you’re uninsured.
“And then the final thing that I want to mention … [that] there’s an organization, it’s incredible, it’s called Remote Area Medical and they do pop-up clinics across the country that offer free medical vision and dental care to anyone. The clinics are often held on weekends.”
Unfortunately, young people are especially at risk in our system. For example, there was a young man by the name of Alec Smith who died after rationing insulin when he aged off his parents’ health plan. Tell us a little bit more about his story and what it reveals about the human cost of gaps in our healthcare system.
Madley: “… his story and also just the advocacy that his family has gone on to do for people who struggle like Alec did is just, it’s awe inspiring but also it’s so illustrative of why we really need to rebuild our entire healthcare system.
“And so really as you mentioned, Alec aged off his parents’ insurance, which for those who may not know, happens when you turn 26. And it’s often a time of … at least a short gap in people having health insurance because oftentimes you turn 26 and it takes a little while to get enrolled in your employer sponsored plan if you have that or for you to buy your own plan.
“A lot of people [at that age] maybe don’t have access to employer sponsored health insurance and so they end up being uninsured and having those periods of time of being uninsured is a huge detriment to your health because not only are you going to, you know, cross your fingers and hope you don’t end up in the emergency room, but you’re gonna avoid things like primary care, like preventative screenings for things like cancer, things like that. And so it’s really a detriment to your health.
“…I think with Alec’s story, like I was saying before, it’s just so enraging that the medication that he needed, and that people who have passed away from rationing their medication needed, is right behind the pharmacy counter.
“And the only reason that they did not get it and that they are not here with us today is because of our profit driven system.”
Helpful Links
An Open Letter to Anyone Who Might Find Themselves Uninsured, HEALTH CARE un-covered
Obamacare Premiums Surge in a Dozen States for 2026, HealthPoint
Why ACA Premiums Are Going Up in 2026, Healthcare Insider
Search for a Federally Qualified Health Center: Health Center Locator Tool, Health Resources and Services Administration
Accessing Healthcare From a Federally Qualified Health Center (FQHC), Health Services Advisory Group
Remote Area Medical Volunteer Corps
Hundreds line up overnight in Takoma Park for free medical, dental and vision care, WUSA 9
Trump’s ‘Big Beautiful Bill’ is deadly to already vulnerable groups across the U.S., Prism Reports
Episode Transcript
Read the full episode transcript.
Guest Biographies: Rachel Madley
Rachel Madley, PhD is the Director of Policy and Advocacy at the Center for Health and Democracy. She previously worked as health policy advisor to Congresswoman Pramila Jayapal and in the legislative affairs office at the U.S. Food and Drug Administration.
Rachel received her PhD in Microbiology and Immunology from Columbia University where she was also a member of the executive board of Students for a National Health Program and Physicians for a National Health Program.
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