Millions of soon-to-be uninsured Americans are looking for a ‘plan B’ : Shots
Robert and Emily Sory open an animal sanctuary at their home in Thompson Station, Tennessee. In 2026, they plan to no longer be insured. They are looking for ways to pay for their care without coverage.
Blake Farmer
/WPLN News
hide caption
toggle caption
Blake Farmer
/WPLN News
It’s feeding time for the animals at this property outside of Nashville. 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 also includes Russian foxes, African porcupines, emus, bobcats and a few well-fed goats.
The Sorys are passionate about their pets and seem to put the animals’ needs before their own.
Robert and Emily will start 2026 without health insurance.
Robert had been covered by a marketplace plan subsidized by the Affordable Care Act Marketplace. His share of the monthly premiums? Zero dollars.
Robert Sory gives a treat to a blind raccoon before the evening meal.
Blake Farmer/WPLN
hide caption
toggle caption
Blake Farmer/WPLN
When he looked at pricing for 2026, he found that a simple “Bronze” 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 expire this month. An estimated 4.8 million people are expected to remain without coverage.
But even without a health plan, people will still need medical care. Many of them, 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, it cost her $184.
“To equate that to what we think, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, which only eat meat.
Finding Workarounds for the Newly Uninsured
To keep the kibble in the food bowls, the Sorys are preparing for an uncertain future. They both consult the same psychiatrist and meet with him. He said 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, usually I go to the emergency room where they’ll bill me later and I can get a [re-payment] plan.”
Emily Sory feeds gray foxes at her home in Thompson’s Station, Tennessee.
Blake Farmer/WPLN
hide caption
toggle caption
Blake Farmer/WPLN
Emily suffers from costly health conditions 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 don’t know other ways to get medical care.
“We don’t have money for marketing, so you’re not going to see big billboards or radio ads,” said Katina Beard, CEO of the Matthew Walker Comprehensive Health Center in Nashville, Tennessee. It is one of 1,400 Federally Qualified Health Centers (FQHCs) nationwide.
FQHCs are partially funded by the federal government. Although they don’t typically offer free care, their prices tend to be lower or variable.
“It’s likely they’ll get a bill,” Beard said. “But the bill will depend on their ability to pay.”
Many FQHCs also have their own 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.
Robert Sory prepares to feed meat to a bobcat.
Blake Farmer/WPLN
hide caption
toggle caption
Blake Farmer/WPLN
Participating pharmacies must make medications available free of charge to uninsured people 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 are planning?’” he said. “Overall,” he said, pharmaceutical companies have said they are ready to step up their efforts.
“Their strategy, their position, their outlook is still a question in play. So it’s an ongoing conversation that we’re having,” Cornwell said.
Ten states still have a “gap” with Medicaid
Hospitals will also have to find a way to care for more patients who can’t pay. Industry groups like 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 who don’t have unemployment 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.
According to the Urban Institute, this Medicaid “gap” is expected to drive uninsured rates up to 65 percent in Mississippi and 50 percent in South Carolina.
As Emily Sory pets one of her Russian foxes, she admits that she is keenly aware that she will soon be part of this unfortunate – and 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 story comes from NPR’s health reporting partnership with Nashville Public Radio And KFF Health News.
