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A lot of attention has rightly been paid to the Trump-era degradation of the ACA marketplace, where reduced subsidies (starting in Plan Year 2026) have harmed the subsidy-eligible, and a roughly 40% two-year increase in base premiums has slammed the subsidy-ineligible (e.g., those subjected to the restored income cap on subsidies).
It’s also no secret that employer-sponsored insurance is imposing increasingly untenable costs, especially on employees of small businesses and on low-income employees.
In my work with lawfully present immigrants, earning hourly wages in the $18-25 range, I’ve had a chance to witness what healthcare access in the U.S. looks like to unaccustomed eyes. Examples:
A married couple, both working as dental assistants for different practices: each is offered individual insurance starting at $400/month, and insurance for two at simply double that. Deductibles begin, if I remember right, at $2,500. They are healthy, and can’t imagine paying well over 10% of income for coverage that doesn’t kick in until they spend thousands more. They are uninsured.
