Millions of Americans Are Expected To Drop Their Affordable Care Act Plans. They’re Looking for a Plan B.

It’s feeding time for the animals at this property outside of Nashville, Tennessee. An albino raccoon named Cricket reaches through the wire mesh of his cage to grab an animal cracker, an appetizer treat just before his evening meal.

“Cricket is blind,” said Robert Sory, who is trying to open a nonprofit animal sanctuary with his wife Emily. “A lot of our animals come to us with problems.”

Thompson’s Station menagerie includes Russian foxes, African porcupines, emus, bobcats and a few well-fed goats.

The Sorys are passionate about their pets and seem to put their needs before their own.

Both Robert and Emily started 2026 without health insurance.

Robert had been covered by a marketplace plan subsidized by the Affordable Care Act. His share of monthly premiums was $0. When he looked at pricing for 2026, he found that a “bronze” level plan would cost him at least $70 per month. He decided to forego any coverage altogether.

“When you have no income, it doesn’t matter how cheap it is,” he said. “It’s not affordable.”

Coverage of dumping

Marketplace plans from the Affordable Care Act no longer seem very affordable for many people because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. An estimated 4.8 million people will go without coverage this year.

But even without a health plan, people will still need medical care. Many, like the Sorys, have thought about their plan B to preserve their health.

The Sorys both lost their jobs in November, within days of each other. Robert worked as a farm laborer. Emily worked at a recruitment company and lost her insurance and her job.

“It’s a horrible, horrible market right now. Really tough,” she said.

The first time she had to pay out of pocket for her three monthly prescriptions, the cost was $184.

“To equate that to the way we look at it, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, which only eat meat.

Workarounds for the newly uninsured

To keep the kibble in the food bowls, the Sorys are preparing for an uncertain future. They see the same psychiatrist and meet with him to come up with a plan. He was willing to work with them by charging $125 per visit. They will have to go there every three months to keep their prescriptions up to date.

What if other medical problems arise? They hope for the best.

“I’m not someone who gets sick very often, thank God,” Robert said. “And if I do, I usually go to the emergency room where they will bill me later.” Robert said he would arrange a repayment plan for such bills.

Emily has expensive health issues and has already incurred significant medical debt. “It’s just there and I’ve been accumulating money,” she said. “But I had to go to the doctor.”

Medicine donations and mobile scales

Hospitals and clinics are preparing for the influx of newly uninsured patients. They also worry that people are unaware of other ways to get medical care.

“We don’t have money for marketing, so you won’t see big billboards or radio ads,” said Katina Beard, CEO of the Matthew Walker Comprehensive Health Center in Nashville. It is one of 1,400 federally qualified health centers, also known as FQHCs.

FQHCs are partially funded by the federal government. Although they don’t typically offer free care, their prices tend to be lower or variable.

Uninsured people who receive care receive a bill, Beard said, “but the bill will be based on their ability to pay.”

FQHCs often have on-site pharmacies, and some offer free prescription medications through a partnership with Dispensary of Hope, a Nashville-based nonprofit.

Many hospital pharmacies also partner with this nonprofit, which has distributed medications donated by pharmaceutical companies to 277 locations in 38 states. Participating pharmacies must make the drug available free of charge to people without insurance whose annual income is less than 300 percent of the federal poverty level.

The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes and mental health. Demand is expected to outstrip supply in the new year, according to CEO Scott Cornwell.

“We project and engage with our manufacturers and ask them, ‘Are you ready to contribute to this future status that we anticipate?’ “, he said. “Overall,” he said, pharmaceutical companies have said they are ready to step up their efforts.

“It’s an ongoing conversation that we’re having,” Cornwell said.

A Medicaid “gap” in 10 states

Hospitals will also have to find a way to care for more patients who can’t pay. Industry groups such as the Federation of American Hospitals have decried the threat to hospitals’ financial health and urged Congress to expand enhanced subsidies, which take the form of tax credits.

The impact could be more acute in states like Tennessee, which have not expanded Medicaid to cover people who work but don’t have workplace insurance and can’t afford it on their own.

Ten states have chosen not to expand Medicaid to uninsured and low-income adults – an optional provision of the ACA that is primarily funded with federal funds.

This Medicaid “gap” is expected to drive uninsured rates at the high end of the spectrum up to 65 percent in Mississippi and 50 percent in South Carolina, according to the Urban Institute.

As Emily Sory pets a Russian fox, she admits that she is keenly aware that she will soon be part of this growing population. After all, his last job was as a healthcare worker. Her mother is a nurse.

“I understand the system. And I understand that it’s people like me who don’t pay their bills who suffer. And I feel bad,” she said. “But at the same time, I don’t have money to pay.”

This article is from a partnership that includes Nashville Public Radio, NPRand KFF Health News.