As insurance prices rise, women puzzle through coverage options for their families

As insurance prices rise, women puzzle through coverage options for their families Cynthia Freeman and her husband Brad Lawrence in their apartment in Brooklyn, NY. Because they work freelance jobs as storytellers and podcasters, they rely on their Affordable Care Act insurance to treat Brad's newly-diagnosed kidney disease. José A. Alvarado Jr. for NPR hide caption toggle caption As the clock ticked down on 2025, B. had been agonizing over her family's insurance options. She was looking for another full-time job with benefits, but so far hadn't found one. The premium prices she was seeing for 2026 Affordable Care Act plans were alarming. She had just about decided that she and her husband would drop coverage, and only insure the kids. But it would be risky. "My husband works with major tools all day,'' she said, "so it feels like rolling the dice." (B. asked to be identified by her middle initial because she's worried her insurance needs might affect her ongoing job search.) The family lives in Providence, R.I. Her husband is a self-employed woodworker, and she worked full-time as a nonprofit manager. B. lost her job last spring. She turned to the Affordable Care Act marketplace. The family's "gold" plan cost them nearly $2,000 a month in premiums. It was a lot, and they dug into retirement savings to pay for it, while B. kept looking for a new position. But then Congress failed to extend the enhanced subsidies for those plans, despite ongoing political battles over the issue and a lengthy government shutdown. With subsidies expiring, B.'s family plan will cost even more - almost $3,000 a month in the new year. "I don't have an additional $900 lying around in my family budget to pay for this," she said. Millions of middle-class Americans who have ACA health plans are facing soaring premiums in 2026 - and tough coverage choices after the new rates kick in Jan. 1. And it often falls to women to figure out a family's insurance puzzle. Brooklyn freelancer Brad Lawrence, 54, holds his prescription medication for kidney disease. He and his wife face more out-of-pocket costs in 2026, after enhanced subsidies expired on their Affordable Care Act plan. José A. Alvarado Jr. for NPR hide caption toggle caption Women generally use more health care than men, in part because of their need for reproductive services, according to Elizabeth Tobin-Tyler , a professor at Brown University School of Public Health. Women also tend to be the medical decision makers for the family, she said, especially for the children. "There's a disproportionate role that women play in families around, what we think of as the mental load,'' said Tobin-Tyler, and that includes "making decisions around health insurance.'' Brooklyn-based performer Cynthia Freeman , 61, has been trying to figure out how to keep the ACA health plan that she and her husband depend on. "If we didn't have health issues, I'd just go back to where I was in my 40s and not have health...

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