Joshua and Ashley Durham operate a family medicine practice in Boise, Idaho, and for the first time in their lives, they are without health insurance. The couple started their medical practice at the end of 2023, with Joshua serving as a primary care physician and Ashley handling billing as a pharmacist. They originally purchased coverage for themselves and their two children through the Affordable Care Act marketplace. This year, their monthly premiums for a similar plan rose several hundred dollars to nearly $1,600. To manage the expense, they chose to pay for medical costs out-of-pocket using funds from their health savings account. The couple had about $50,000 saved in the account over several years. Joshua Durham said the decision was stressful and nerve-racking.
Healthcare workers have traditionally had higher rates of insurance coverage compared to other industries, according to dailycamera.com. According to a KFF analysis, 7% of healthcare workers were uninsured in 2024, compared with 11% of all adults under 65. Doctors were especially unlikely to go without insurance, with only 2% uninsured in 2024. At the same time, employers expect their health benefit costs to rise another 8.2% in 2027.
The Republican-led Congress chose not to renew enhanced Affordable Care Act marketplace tax credits that were created during the COVID-19 pandemic. The credits reduced premium costs for people who bought their own insurance and were especially important to many self-employed people and workers at small businesses. In 2024, nearly half of marketplace enrollees were either self-employed or worked for small businesses, including many in chiropractic care and dentistry.
Jack Dillon, executive director of the Association for Independent Medicine, said premium costs have become unmanageable for small practices. He described the current insurance prices as astronomical. As insurance costs rise, more employers may shift to offering higher wages or minimal coverage instead of full plans.
The Congressional Budget Office estimates that President Donald Trump’s 2025 budget legislation will reduce federal health spending by about $1.1 trillion over a decade. Healthier individuals are more likely to drop insurance coverage, which reduces the number of people covered and increases costs for remaining enrollees. This leads insurers to raise prices further, creating a cycle that makes insurance even more expensive. The expiration of the enhanced ACA tax credits and changes in the federal budget law are projected to increase the number of uninsured Americans by roughly 15 million over 10 years.
Samantha LeGault, a nurse practitioner at a health clinic in Boise, said her monthly premium increased from $700 to $1,500 this year. She has Crohn’s disease and two of her daughters also have medical conditions, so she must continue paying for health insurance. However, she decided to skip dental coverage to save money and prioritizes dental care for her children over herself. LeGault had already switched her children from private to public school and struggled to set aside money for retirement. The new insurance costs have made it even harder for her to manage expenses. She estimated that about one-fifth of her income now goes toward monthly premiums. LeGault said she knows that she is an expensive patient at the clinics where she seeks care.
The Durhams employ three other employees in their practice. Two of the employees receive insurance coverage through their spouses. The couple pays $420 monthly toward their physician assistant’s health insurance premiums.
Joshua Durham, as a primary care doctor, said he doesn’t need regular visits to doctors because he can diagnose and treat himself or his family. He acknowledged that this practice is generally discouraged by the American Medical Association’s code of ethics. However, exceptions are made for emergencies or short-term minor medical problems.
Ashley Durham has filled prescriptions for her family members when needed. Bioethicist Arthur Caplan said that as more people rely on relatives for care due to lack of access, the medical code may need reevaluation.
Healthcare workers with less advanced training often do not have the option to treat themselves or family members. Many also lack sufficient savings for out-of-pocket medical expenses.
Jill Kordick, a 64-year-old retired healthcare executive in Iowa, is among those who prefer not to go without insurance coverage. Her monthly premium increased from $75 last year to $800 this year after the enhanced ACA tax credits expired. She also has a $10,000 deductible.
In another part of the country, Starbucks workers are also feeling the pressure from rising health costs, according to a report from The Guardian. A survey of more than 130 Starbucks employees found that many workers face higher health insurance premiums beginning October 1. The increases come amid an ongoing labor dispute involving Starbucks Workers United.
One worker said she made too much to qualify for state coverage but not enough to afford her employer’s plan. She added that she now has no insurance at all. She explained how the rising costs of utilities also impact her ability to afford other necessities. Another Starbucks employee said his insurance premium was rising from $70 to $122 per paycheck and that he was considering taking a second job.
Starbucks said rising healthcare costs are affecting employers across the country and said the company remains committed to providing affordable coverage to eligible full-time and part-time employees.
IMAGE: Author Harrison Keely CC4