A real-world example of having your premiums increase by infinity percent.

Almost exactly 10 years ago, The Onion published one of their classic headlines:

Company’s HR Manager Really Pushing Infinite-Deductible Health Care Plan

During a meeting with new hires Wednesday to discuss employee benefits, Radian Analytics human resources manager Ellen Schultz is said to have strongly pushed the company’s infinite-deductible health care option.

According to sources in attendance, Schultz described the low-premium, infinite-deductible plan as the simplest and most convenient choice available to employees, and said it works the same whether plan members need to visit their primary care physician, fill a prescription, or be admitted to a hospital, allowing them in each case to pay 100 percent of the incurred medical expenses.

I was reminded of this yesterday when I read this USA Today published an excellent story by Sarah Wire which looks at the real-world impact of the pending ACA tax credit expiration on several households. It's a great read & highly recommended, including shout-outs to, among others, Katherine Hempstead of the Robert Wood Johnson Foundation (disclaimer: RWJF is a sponsor of this site) as well as Louise Norris of healthinsurance.org & verywell health.

Wire's story focuses on three specific case studies:

• A 55-yr old woman & her husband from Traverse City, Michigan
• A 52-yr old restaurant owner in Richmond, Virginia
• A 47-yr old business owner in Middleton, Wisconsin

The first of the three examples caught my eye for two reasons:

First, the couple live in my home state of Michigan; and second, it lists exactly what they're paying now ($0/month) compared to what they expect to pay if the enhanced tax credits expire ($1,500/month):

Victoria Sylvester and her husband have discussed divorcing ‒ just on paper ‒ to protect their assets if her health care costs tip her into bankruptcy.

Their health insurance premium is expected to jump from $0 to $1,500 a month when the premium tax credits they’ve relied on end later this year.

...For Sylvester, 55, of Traverse City, Michigan, having health insurance isn’t optional.

In 2022, Sylvester was diagnosed with Stage 3 ovarian cancer, and while it is in remission now, it has a high rate of recurrence. She needs frequent checkups and testing to catch it quickly if it comes back. And she still receives treatment for some side effects from chemotherapy.

...She is already examining their budget to try to find the extra money. She and her husband are both self employed.

You may find it surprising and implausible that a middle-class couple could see such a dramatic increase (from $0 to $1,500? An infinite premium hike, really?), but there are millions of Americans in similar situations.

Let's take a look at Ms. Sylvester & her husband's situation based purely on the information provided in this story.

We know their hometown (Traverse City, Michigan). We know her age (55) but not his. We know they're both self-employed. And critically we know that they're currently paying $0/month and expect this to jump to around $1,500/month next year if the enhanced subsidies expire at the end of December.

First, visit HealthCare.Gov's "Window Shopping" tool.

Enter any zip code for Traverse City, Michigan (it doesn't really matter which one, the point is to bring up Grand Traverse County).

For the "tell us about your household" section, enter "married." The story mentions "visiting their children and grandchildren" so I'm assuming they have no dependents.

We know she's 55 years old but don't know her husband's age. I'll assume he's 56 for the moment.

I also don't know their income, but in order for them to jump all the way from a $0-premium plan to $1,500/mo, I'm assuming they earn slightly over 400% of the Federal Poverty Level (FPL) since that's the point where any tax credit eligibility would cut off instantly. This was known as the dreaded "Subsidy Cliff" up until 2021 when the subsidy upgrade was first signed into law by President Biden.

400% FPL for a 2-person household in Michigan is $81,760 this year, but next year it will increase to $84,600 (for purposes of ACA tax credit eligibility, the FPL table is always one year "behind" the year listed in these tables for reasons I've never quite understood).

I'm therefore assuming their combined gross income is perhaps $85,000 this year and that they expect it to be around the same in 2026.

If so, that would make them eligible for $1,143/month in tax credits this year...but $0/month in tax credits starting January 1st.

Next, we look at the plans available for them to choose from (I don't know which of these will still be available for 2026 yet, but am assuming the list of plans will remain identical).

With $1,143/mo to work with, the least-expensive plan for them is a Bronze HMO from Blue Care Network of Michigan for $74.27/month ($1,217.27/mo at full price).

Not quite $0/month, however, so let's play around with her husband's age and their combined income a bit.

If I assume he's 60 years old, their subsidies increase to $1,288/mo and the net premium for the same Bronze HMO plan drops to $30.91.

If he's 63 years old, subsidies go up to $1,379/mo and the Bronze HMO drops to $3.41/mo...and if he's 64 years old, the credits are $1,398/mo, which is indeed more than the gross $1,395.21 premium, resulting in...yep, a $0/mo net premium for Mrs. Sylvester & her husband.

If he's 64 then he'll presumably become eligible for Medicare partway through the year, at which point their situation would change significantly.

Now let's look at the other end, the "$1,500/month" estimate for 2026. The current gross premium for the Bronze HMO is $1,395 (again, assuming her husband is 64 years old), but don't forget that Michigan ACA carriers have requested an average rate hike of 17% (16.3% for Blue Care Network specifically).

Assuming the BCN Bronze HMO plan goes up exactly 16.3%, the gross premium would increase to $1,622/month. If it only goes up by 7.5% that would be exactly $1,500.

There's another factor as well: Both Mrs. Sylvester & her husband will be a year older in 2026. At 56 & 65 respectively (I'm setting aside her husband's potential Medicare eligibility for now), the gross premium would be $1,422.68/mo + 16.3% = $1,654.58/mo.

Again, I don't know how old her husband is, nor do I know that they earn $85,000/yr. Their income could be a bit higher or lower; her husband could be a few years lower. I also don't know for certain that they're enrolled in the BCN Bronze HMO plan, as there could be some other factor I'm unaware of.

Hell, for all I know, they're actually paying a nominal amount ($3 - $4/month?) and Ms. Sylvester just told the reporter that they're "basically paying nothing" which Wire interpreted as being literally $0. (Update: Ms. Wire clarifies that Ms. Sylvester did specifically state that they're currently paying $0/mo.)

None of this is really the point, however.

The point is that yes, there are absolutely plenty of regular real world Americans who will see their health insurance premiums skyrocket from 0% (or nearly 0%) to 21% or more of their gross incomes literally overnight for the exact same policy.

Here's some examples of other household/income scenarios from Michigan (although all of these are based on Lansing, not Traverse City).

Oh yeah...and remember, this is for a Bronze HMO, which means their out of pocket maximum is $18,400...which will likely increase to a stunning $21,200 in 2026 thanks in part to other changes made by the Trump Regime earlier this year.

...which means they could theoretically be on the hook for as much as $39,000 in total healthcare expenses if her ovarian cancer returns or either of them have some other catastrophic medical expense...on a combined income of (again, I'm assuming) around $85,000/yr.