A single mom's ACA premium jumped from $3 to $164. Now she's skipping her medications.

• Natalie Richards, 37, can no longer afford her ACA marketplace health insurance.
• Millions of Americans are being priced out of coverage in 2026 because enhanced subsidies lapsed.
• Richards can no longer afford her medications and is likely to become uninsured.

Natalie Richards is overwhelmed.

Her monthly health insurance premium jumped from $3 to $164 a month in January, a cost too high for the single mom's tight budget. Her job as a dishwasher at Chili's barely covers rent, groceries, and other essentials. Like many Americans, Richards relies on the Affordable Care Act marketplace because her job doesn't offer health insurance.

With such a steep premium increase, she fears she'll lose her medical coverage.

"It's life or death," Richards, 37, told Business Insider. "And beyond that, it's quality of life. I could be completely miserable and struggle for everything. Or, when I have my meds, I can look at problems, see the bigger picture, and figure it out."

Her past jobs at nonprofits and in hospitality generally haven't offered employer-based health coverage, so Richards has relied on the marketplace. The plan has helped her afford medications and therapists to manage her ADHD, which she said can be debilitating without proper care.

Millions of people like her lost access to enhanced ACA subsidies this year, a credit designed to help lower- and middle-income households pay for healthcare. These government-subsidized plans were a lifeline for freelancers, gig workers, part-time workers, and others without employer-sponsored coverage. The credits expired on December 31 after months of tension in Congress — and efforts to renew them have gone quiet.

Enrollment in the marketplace dipped by 1.4 million in January, with more people expected to drop their plans in the coming months. Twenty-four million people were enrolled in ACA plans in early 2025, a figure that had steadily increased since the enhanced subsidies took effect in 2021. Richey said her plan rolled over from last year and that she expects it to lapse in the next few months due to unpaid premiums.

"The things I desperately need right now, I don't have access to," Richards said. "This is probably the hardest time in my life."

Without ACA subsidies, Richards is losing her 'stability'

Healthcare isn't Richards' top spending priority. From a budget standpoint, it can't be. She said she earns slightly above minimum wage and is doing her best to pay for housing, utilities, and food. She doesn't have a car and desperately needs one to commute between work and appointments — public transportation is limited in her small city of Palestine, Texas. After these costs are covered, she can't afford a doctor's visit out of pocket.

"I've been in crisis mode," she said, adding that she plans to treat any potential illness or injury at home, and she skipped her most recent prescription refills.

Beyond the ACA, Richards doesn't have insurance options. Texas Medicaid is only available to low-income children, pregnant women, seniors, and people with disabilities, so she doesn't qualify. Texas is one of 10 states that didn't expand Medicaid under the ACA. It leaves Richards stuck: Her current job doesn't offer an insurance plan because her schedule is part time. She's looking for a new role with stable coverage, but hasn't had any luck yet.

Richards is most worried about losing mental health support. Allowing her marketplace plan to lapse means she would no longer be able to reliably see therapists and get prescriptions refilled, which she relies on for everyday function. She also shares custody of her teenagers with their father, and losing healthcare jepordizes her ability to reliably track her mental and physical health. The ripple effects are frustrating, she said.

"I'm losing the ability to document that I am the capable parent that I say that I am," Richard said, adding, "It's my stability, my capacity, my credibility — it's all at risk as a direct result of not having healthcare."