"Mathew asked NPR not to use his full name because he fears repercussions from his health insurance company if they find out he got married to obtain coverage. He is not the first American to marry for health insurance, and he won't be the last. Especially before the Affordable Care Act, marriages, delayed divorces, and job decisions were often tied to private health insurance, since it could only be obtained if you had a job with benefits."
"But his decision was forced by the cost crisis facing many of the roughly 24 million people who get their health care via Affordable Care Act marketplaces. Enhanced subsidies that made plans affordable for many people expired at the end of 2025 and Congress failed to extend them before the 2026 plan year. Millions of people face untenable monthly premium prices as much as the cost of a mortgage for some families."
"In the meantime, some have decided to forgo insurance or make drastic changes to their lives to stay insured, like Mathew. "I couldn't afford to wait for Congress to make up their minds and come to an agreement," he says. 'That's so weird' Mathew is 40 years old and lives in a small town in Michigan. He loves his job, but the company is too small to offer health coverage and he has an auto-immune condition that requires medication transfusions."
Enhanced Affordable Care Act marketplace subsidies expired at the end of 2025 and Congress did not extend them before the 2026 plan year. Millions of people who rely on marketplace plans now face steep monthly premiums, in some cases comparable to mortgage payments. Some people are choosing to forgo insurance or make major life changes to maintain coverage. One individual with an autoimmune condition married his best friend to obtain spousal health benefits and preserve access to necessary medication transfusions while fearing insurer repercussions.
Read at www.npr.org
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