When the US Congress allowed the Affordable Care Act subsidies to expire on Dec. 31, 2025, they created a health insurance crisis that could have inspired a plot line for “American Horror Story.” Overnight, millions of Americans saw their premiums expand and rise like mushroom clouds from a nuclear explosion. In an article posted January 1, 2026, Peter Welch, Democratic senator from Vermont, told NPR about one of his own constituents: “Their premium is going to go from $900 a month to $3,200 a month.”
This debacle is just the most recent gasp of a wounded healthcare system that sucks up over a third of our yearly health expenditures in administrative costs. Gaining access to medical care means running an obstacle course where the rules can change at any time.
When we reach age 65, we are eligible for Medicare, a government-issued insurance intended to provide a lower-cost, comprehensive alternative to individual market plans. But there are glitches in the guidelines that can turn Medicare into a nightmare for low-income Americans.
In 2014, at age 61, “Mandy” qualified for insurance under the ACA. It was a wondrous gift. She hadn’t been able to afford health insurance as a freelancer for over 25 years. But on her 65th birthday, she received an unwelcome surprise. Her ACA insurance had been canceled and she had been automatically enrolled in Medicare. There were complex decisions to be made and lifetime penalties to be feared. She went from having free healthcare to being forced into a monthly premium accompanied by additional co-pays for service. It would be a full year before she could retire and have premiums deducted from Social Security, so after paying her premiums Mandy couldn’t even afford to visit her doctors.
She had hoped that her Social Security income would provide some relief, but after Medicare deductions, her monthly check came to only $900. As her assets dwindled, her medical needs increased. Desperate, Mandy made an appointment with Rhode Island DHS to see if she could qualify for Medicaid assistance. Here she received shock #2.
Before age 65, in order to qualify for ACA assistance all the government looked at was her income. If it was below the national poverty level, they paid for her healthcare. But once she turned 65, the government changed the rules. It no longer mattered how little income she had. If she had savings of over $4,000, Medicare wouldn’t give her squat.
Rhode Island is lucky – in most states, the limit is $2,000. Take a moment to consider how long you could live on $2,000 and you will realize that, in essence, the government is saying, “Screw You,” to low-income residents who manage to cache anything at all for retirement. But the “screw you” doesn’t end there. While 68% to 89% of doctors may be enrolled in Medicaid, very few actively treat patients. If you are uninsured or if Medicaid is the only insurance you have, these organizations can help: https://www.providencechc.org/ and https://www.rifreeclinic.org/.
Mandy made the best of Medicare by finding an advantage plan with a private company for $0, with premiums and perks that regular Medicare didn’t offer. She could get rides to the doctor if she didn’t have a car. They gave her an allowance for over-the-counter medications. When she had surgery, the plan delivered two weeks of frozen meals to her home. Her co-pays were lower and her primary care doctor was free. For the first time in many years, she felt a sense of security.
But in 2026, the advantage plan that had provided her with so many extras disappeared. When she finally found a new company with a plan that worked for her, there was a major problem: Her primary care doctor, whom she had been with for nearly 12 years, was not in their network.
This problem is not unheard of, but in the state of RI there is a rift between two healthcare organizations, which complicates our network issues even further. On July 1, 2025, every Brown University Health hospital, including Rhode Island Hospital, Miriam Hospital, Hasbro Children’s Hospital, and Newport Hospital, became out-of-network for most United Healthcare’s Medicare Advantage plans. If Mandy wanted to keep her primary care doctor she’d be shut out of every hospital and clinic she’d been going to for the last 30 years. The only alternative was an advantage plan in Brown’s network that cost more and gave her less coverage. This was not a choice she should have been forced to make.
Insurance shouldn’t be as painful as the health issues it is meant to cover.
It’s a medically known fact that stress is a major contributing factor for disease, addiction, and early death. Considering the degree of trauma and anxiety that this insurance uncertainty generates, one has to ask: Is the goal of our current healthcare system to cure us…or to keep us coming back?
For help with insurance:
healthsourceri.com
shiphelp.org/ships/rhode-island
retirementmadeez.com