Maine Pasta Business Owner Considers Dropping Health Insurance Amid Rising Costs

A small business owner in Thomaston, Maine, is contemplating dropping her health insurance due to escalating costs and the expiration of federal subsidies, raising concerns about the future of the health insurance market. Chloe Chalakani, who operates a handmade pasta business with her partner, is facing significant financial pressure as she navigates the complexities of health insurance enrollment.

Chalakani currently pays a monthly premium of $460 for a high-deductible plan. At just 31 years old and in good health, she is evaluating her options as the expiration of enhanced tax credits approaches in December 2023. The loss of these subsidies means that her costs are set to increase, prompting her to reconsider her coverage. “I don’t plan to get insurance next year,” she stated. “I’m just not going to do it — I’ll pay out of pocket.”

The potential for young, healthy individuals like Chalakani to forgo insurance raises alarms among health policy experts. They warn that if a significant number of young people opt out of the Affordable Care Act (ACA) markets, it could destabilize the entire system. The viability of health insurance markets relies on a diverse pool of enrollees, including both young and older individuals, as well as healthy and less healthy participants.

“You need people to be paying into the insurance system when they’re healthy so that they can take out when they’re sick,” explained health policy analyst Jennifer Cox. Younger individuals typically contribute more in premiums than they consume in health care services, which helps offset the costs incurred by older and sicker individuals who require more care.

As federal subsidies expire, the financial burden on consumers is expected to increase. Cox emphasized that the demographic most likely to abandon health insurance will be younger and healthier individuals, while older individuals are generally more motivated to maintain their coverage despite rising costs. She noted that if only the sickest individuals remain in the insurance market, it can lead to unsustainable premium hikes, ultimately driving insurance companies away from participation.

The implications of a shrinking insured population extend beyond individual financial decisions. An increase in uninsured patients can place significant strain on hospitals and health care providers. “If hospitals face a lot of financial strain from having more uninsured patients coming through their doors, they might start changing the services they offer,” Cox said. Such changes could include reductions in essential services, potentially even leading to hospital closures.

Chalakani is among approximately 24 million Americans who rely on the ACA for their health insurance. Though she acknowledges the risks associated with being uninsured, she feels compelled to prioritize her financial stability. “Should a catastrophe happen, I’ll probably say, ‘Wow, I should have had insurance,’” she reflected. Yet, at this moment, she lacks the financial ability to plan for potential medical emergencies.

The situation is exacerbated by looming cuts to Medicaid under federal budget proposals, which could push millions more Americans into the ranks of the uninsured. As Congress grapples with these issues, many enrollees may face significant sticker shock when they seek new plans for 2026.

Chalakani remains hopeful that lawmakers will act to extend the enhanced subsidies, which would encourage her to reconsider her decision regarding health insurance. For now, she is focused on running her culinary business while navigating the uncertainties of health care costs in the coming year.