THIS TIME ON CODE WACK!
As of spring 2026, enhanced Affordable Care Act (ACA) subsidies have not been extended. Without congressional action, millions of Americans could face significantly higher premiums—or lose coverage altogether.
Around 22 million people receive ACA premium subsidies, many of whom benefited from pandemic-era enhancements. If those aren’t restored, affordability for individuals buying their own coverage will take a major hit.
Meanwhile, health care costs are rising across the board. Employer-sponsored insurance premiums have seen some of the largest increases in over a decade, shifting more costs to workers through higher premiums, deductibles, and out-of-pocket expenses. Medicare premiums are also climbing, adding pressure on older adults.
As coverage becomes less affordable, many people delay care, skip medications, or make tough financial tradeoffs just to get by.
So what options do people have?
Today, we revisit a timely 2025 conversation with Rachel Madley, executive director at the Center for Health and Democracy and former advisor to Congresswoman Pramila Jayapal.
Check out the Transcript and Show Notes for more!
And please keep Code WACK! on the air with a tax-deductible donation at heal-ca.org/donate.
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
Obamacare Premiums Surge in a Dozen States for 2026, HealthPoint
Employer Health Insurance Costs: What to Do Now, Elite Medical
Medicare Warning: Premiums Set to Double, Newsweek
Americans’ Challenges with Health Care Costs, KFF
9% of ACA health-care plan enrollees go uninsured after enhanced subsidies expire, poll finds, CNBC
An Open Letter to Anyone Who Might Find Themselves Uninsured, HEALTH CARE un-covered
“I Don’t Have Insurance”: How to Get the Healthcare You Need, National Association of Free & Charitable Clinics
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
Guest Biography: Rachel Madley
Rachel Madley, PhD is Executive Director 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.
Host Biography: Brenda Gazzar
Brenda Gazzar, the host and co-producer of Code WACK!, has produced over 300 weekly podcast episodes, topping 400,000 downloads. A skilled interviewer and storyteller, Brenda brings nuance, curiosity, and clarity to every conversation.
Brenda has worked as a multilingual and award-winning reporter with more than two decades of experience in California and the Middle East.
Her work has been published by Reuters, Ms. Magazine, USA Today, Los Angeles Daily News, the Orange County Register, The Wrap, The Jerusalem Post, Cairo Times, and numerous other publications. She speaks Spanish, Hebrew, and moderate Arabic and is the recipient of national, state, and regional awards.
Brenda also enjoys being a life coach, helping people align with their purpose so they feel fulfilled while achieving their boldest dreams.
Brenda’s work is grounded in a belief that systemic change and personal growth go hand in hand, and she’s here for both.
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Keywords:
healthcare access, insurance coverage gaps, Medicaid cuts, ACA subsidies, uninsured Americans, health equity, healthcare affordability, free clinics, community health centers, Remote Area Medical, public health policy, medical debt, prescription costs, patient assistance programs, short-term health plans, healthcare reform, Medicare for All, preventive care, healthcare justice, US healthcare system
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