A mechanic in North Carolina is mostly blind in one eye and now has no health insurance, because his monthly premium just jumped from $130 to $550. That's not a cautionary tale about the healthcare system failing. That is the healthcare system working exactly as currently designed. And his family is one of potentially 5.5 million people who will lose ACA coverage this year alone.
From $30 a Month to 'Not Worth It Anymore'
Ross and Rebecca Tobiassen have owned a small auto shop in Sugar Grove, North Carolina since before Obamacare existed. When the ACA launched in 2014, they signed up immediately and paid about $30 a month. That felt like something. That felt like the government actually giving a damn.
Over the next decade, CBS News reports, they watched their premiums climb steadily. They switched from a silver plan to a bronze, the cheapest option available, cutting benefits to keep costs manageable. Then came December 2025, when Rebecca checked their premium for 2026 and saw the number: $550 a month. Up from $130. A 323% increase. They canceled.
"It makes no sense," Rebecca told CBS News. "It's not worth it anymore." Which is a perfectly rational response to a completely irrational situation.
What Actually Happened Here
This is not some mysterious market force. There is a direct and traceable cause. The Biden administration's American Rescue Plan Act created enhanced tax credits that dramatically lowered ACA premiums for millions of families during the pandemic. Those credits worked. ACA enrollment doubled, reaching about 24 million people, according to CBS News.
Congress let those enhanced subsidies expire at the end of 2025. That's it. That's the whole story. The government built a floor, people stood on it, and then the floor was removed. Now they're falling.
An early analysis from KFF, citing Wakely Consulting Group research, projects enrollment could drop from over 22 million at the end of 2025 to as low as 16.5 million in 2026. That's potentially 5.5 million people joining the uninsured. In North Carolina alone, individual ACA signups for 2026 were already down 22% compared to the prior year, a bigger drop than any other state, amounting to more than 213,000 fewer people covered.
The Guy Who Already Lost an Eye
Here is the part that should make you put your phone down for a second. Ross Tobiassen, 47, is a mechanic. The work is physical and genuinely dangerous. CBS News describes a spring that once shot a metal ball joint into their garage wall like a bullet. A heavy object crushed Ross' thumb. In 2020, he developed a severe eye infection from repeatedly getting metal shards in his eyes on the job, and he lost most of his vision in one eye.
His doctor told him a cornea replacement could fix it. Cost: up to $30,000, plus six months off work. So Ross chose a cheaper option that killed the nerves in the eye instead. He still went to work. He's still going to work, sometimes into the night, now without any insurance at all.
"I try not to think about it too much," he told CBS News. "I just work." That sentence is the American healthcare system summarized in nine words.
This Is Happening Everywhere, Not Just in North Carolina
Katie Alexander coordinates volunteers for Pisgah Legal Services, a western North Carolina nonprofit that helps low-income people get health coverage. She has been doing this since the ACA launched. She told CBS News she has never seen anything like this year. Nearly 100 of her roughly 700 clients dropped insurance entirely during open enrollment. Many others downgraded to plans with less coverage.
The people dropping out are not reckless. CBS News describes Lyft and Uber drivers, people starting small businesses, artists, part-time workers who are chronically ill and cannot physically work full-time. These are people who already exist in the gaps of employer-sponsored coverage and make too much for Medicaid. They had one option and now that option costs more than their rent.
"Even for folks who don't have chronic illnesses," Alexander told CBS News, "there's just this nagging at the back of your mind, kind of constantly, of: 'Don't get hurt. Don't get sick. Because you can't afford that.'" Millions of Americans are now running their daily lives around that calculation.
The Death Spiral Nobody Wants to Talk About
There is a well-understood mechanism in health insurance called the risk pool, and what is happening right now is about to make everything worse in a very predictable way. Healthcare policy researcher Risha Gidwani at the University of Colorado Anschutz School of Medicine explained it to CBS News: when healthier people drop out of the insurance pool because they can't afford premiums, the remaining pool skews sicker. Fewer healthy people are subsidizing the costs of sick people. So premiums rise again. Which pushes more healthy people out. Repeat.
Gidwani and health economist Cheryl Damberg published research this year showing that most bronze plans, the cheapest ACA option available, would be unaffordable for the average enrollee without subsidies. The subsidies are gone. The plans are still there, technically. Just not for people without money. "Plans are unaffordable, no matter how you cut it," Gidwani told CBS News. "It's just who is shouldering the unaffordability."
Right now, families like the Tobiassens are the ones shouldering it. With their bodies.
The Dingo Take
Let's be precise about what expired here. Congress didn't repeal the ACA. They just let the part that made it actually affordable quietly die, which is a more elegant form of sabotage. You get to keep saying "Obamacare still exists" while millions of people can't afford to use it. The program survives on paper. The coverage does not survive in practice. That's a pretty clean trick if you're opposed to people having healthcare but don't want the political heat of an outright repeal vote.
And the cruelty is specific. The people dropping off are not the wealthy self-employed with savings cushions. They are mechanics going blind in one eye. They are Uber drivers. They are the chronically ill working part-time jobs because their bodies can't do more. The people who need insurance the most are the ones being priced out first, because that's how markets work when you let them run unchecked through something as non-optional as human health.
Rebecca Tobiassen told CBS News: "We've known that you don't care about us, but you're making it plain and simple now." She's right. There is nothing ambiguous about letting 5.5 million people lose health coverage in a single year. That's not a policy failure. That's a policy choice. The question is whether anyone with actual power finds it embarrassing enough to do something about it before Ross Tobiassen needs that cornea surgery and has absolutely no way to pay for it.
