Joshua and Ashley Durham, owners of a family medicine practice in Boise, Idaho, have found themselves without health insurance for the first time in their lives. The couple, who have two kids, bought coverage on the Affordable Care Act marketplace when they started their practice in 2023, but their monthly premiums rose to nearly $1,600 this year.
They decided to pay out-of-pocket for medical expenses instead, using $50,000 they had set aside in a health savings account. “It’s nerve-racking,” said Joshua Durham, 47. “It just takes, you know, one little accident, and then you got a big fat bill.”
Rising Health Insurance Costs
Nationwide, 7% of all healthcare workers were uninsured in 2024, compared to 11% of all adults under 65, according to a KFF analysis of the most recent American Community Survey data. Doctors were especially unlikely to forgo health insurance, with just 2% uninsured. However, even healthcare workers are feeling the pinch as health insurance costs rise each year, with employers expecting an 8.2% increase in costs for 2027.
The Republican-led Congress opted not to renew Affordable Care Act marketplace credits enacted during the covid pandemic, which helped reduce premium payments for many consumers, especially those working in small businesses. Nearly half of marketplace enrollees worked for small businesses or were self-employed in 2024, with common occupations including chiropractic care and dentistry.
Jack Dillon, executive director of the Association for Independent Medicine, said premium increases have become untenable for small businesses. “The cost has become so astronomical,” Dillon said. “You’re looking at it and saying, ‘What’s the value?'”
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As health insurance continues to become less affordable, Dillon said more healthcare employers may seek alternatives to standard coverage, such as providing higher hourly wages or minimal plans. The number of people without insurance in the U.S. is expected to increase by roughly 15 million over 10 years due to the expiration of expanded ACA subsidies and estimated cuts from President Donald Trump’s signature One Big Beautiful Bill Act.
Samantha LeGault, a nurse practitioner at a health clinic in Boise, said her employer-offered plan’s premium payment rose from $700 to $1,500 a month this year to insure herself, her husband, and four of their kids. LeGault has Crohn’s disease and two of her daughters also have medical conditions, so she said her family has no choice but to continue paying for health coverage.
However, she decided to skip dental insurance to save money and prioritizes dental visits for her children over herself. She estimated that about one-fifth of her income now goes toward monthly premium payments. “I know how the clinics work, that I am an expensive patient,” LeGault said. “At the end of the day, healthcare is a business in the United States.”
Healthcare Workers Feel the Pinch
The Durhams have three other employees in their practice, two of whom receive health insurance through their spouses. The Durhams pay $420 monthly toward their physician assistant’s premiums.
Arthur Caplan, a bioethicist and professor emeritus at New York University’s Grossman School of Medicine, said that as more people turn to relatives for medical care due to lack of access, it may make sense to revisit the code of ethics. Healthcare workers with less advanced medical certifications often don’t have the option of treating themselves or family members, or don’t have savings to fall back on for healthcare expenses.
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Jill Kordick, a 64-year-old retired healthcare executive in Norwalk, Iowa, isn’t willing to go without the safety net of insurance. She qualified for enhanced Affordable Care Act tax credits last year, allowing her to pay $75 a month for health coverage, but her premiums rose to $800 a month this year when those subsidies expired. Kordick has a $10,000 deductible and put off going to the doctor for weeks when she had a sinus infection, until it evolved into an ear infection.
The Durhams have seen the impact of unaffordable healthcare on their patients and try to lend some leeway when they can. In one case, Ashley Durham wrote off $1,160 in bills for a single father whose son didn’t have health insurance rather than send their bills to a collection agency. “It’s hard, because as a human I want to help them out,” she said. “At the same time, we need revenue for our office.”
Joshua Durham is more nervous about going uninsured than his wife, having witnessed his parents struggle to pay medical bills when he was a child. He sometimes exchanges work for care, getting free eye exams from an uninsured optometrist and offering him free primary care. Durham worries about a worst-case scenario, such as a car crash or serious diagnosis, and has paid around $9,000 total for expenses out of their health savings account this year.
Seeking Alternatives
The Durhams’ decision to pay out-of-pocket for their medical expenses has been costly, with expenses totaling around $9,000 so far this year. However, they believe that it has been the right decision for them, at least for now.
