Anne Marie Schneider: How Rising Premiums Push Families Out of Care

Anne Marie Schneider lives in Durham, North Carolina, and has spent more than three decades working across nearly every corner of the health care system. She is an occupational therapist with a hand specialty certification and has worked in hospital systems, private clinics and now her own clinic. Over the past 35 years, she has served as a practice administrator, worked in finance and HR and managed a dermatology practice’s revenue cycle. As she explains, she has been “on the back office side trying to get the providers paid.”

In mid-December 2023, Anne Marie’s decades of experience in health care collided with her own reality when she suddenly lost her job at a dermatology practice. The loss meant her insurance was set to end December 31, and she knew she was unlikely to secure a new job with coverage by January 1. At the time, she was the full-time worker in her household. Her husband was self-employed and relied on her employer-sponsored insurance, and their 23-year-old daughter was still on her plan because it offered better coverage than her own job.

With only days to act, Anne Marie and her husband turned to the ACA Marketplace. Her husband has psoriatic arthritis and relies on medications that she described as “literally saving his joints.” Without insurance, those medications alone could cost thousands of dollars a month. “We could not afford $7,000 a month,” she said, referring to medication and treatment costs without coverage.

Given their circumstances, the family qualified for enhanced ACA tax credits. The subsidies lowered a Blue Cross plan from about $1,800 a month to under $300. The plan offered manageable copays and prescription coverage that allowed them to continue care. Still, the family could not afford to keep their daughter on the plan, and instead helped her enroll in coverage through her employer.

A year later, everything changed. When Anne Marie returned to the Marketplace for 2026, the same plan jumped from $1,800 to $2,700 a month with no changes in benefits. “That was more than my mortgage for the privilege of having health insurance, not health care,” she said.

Without subsidies, the cost was impossible. The couple explored other options, including plans through the local chamber of commerce, but they were denied because of technical eligibility rules. They also considered less expensive insurers but worried about losing access to providers. “I’m not losing all of my physicians that I have relationships with,” Anne Marie said, describing the stress of plans that drop providers or delay payments.

Ultimately, they downgraded to a bronze-level Blue Cross plan costing $1,800 a month. The plan came with steep cost sharing and a $7,000 deductible per person. “For the privilege of having that bronze level plan,” she said, “our co-pays are $95 for our PCPs and $175 for a specialist.”

The financial strain became immediate. Her husband needed a hip replacement and expensive medications that quickly pushed him toward his deductible. At one point, they received a notice stating they owed $6,000 for medication. “I cannot afford a $6,000 bill for medicine,” she said. Prescription assistance programs helped temporarily, but the uncertainty remains.

Anne Marie has seen firsthand how these pressures shape patient behavior. Many self-employed providers she knows have dropped insurance entirely and are “rolling the dice every day.” She worries about what happens when people avoid preventive care because they cannot afford coverage. “If you don’t have insurance and you don’t have money, you don’t take care of your own health,” she said.

She also sees how insurance rules drive inefficiency and burnout. High copays discourage care even after patients meet their out-of-pocket limits. Insurers dictate treatment paths that require unnecessary steps. “You want to pay for six weeks of therapy that we know isn’t going to work before you let me get an MRI,” she said. She described how patients who try to bypass those steps often save money but are penalized for not following insurer requirements.

Anne Marie believes these problems are structural. “Health care truly should not be a business,” she said. She described a system that prioritizes profit over time spent with patients and reimburses procedures over listening, diagnosis and education. “I have friends now who say, ‘I have 12 minutes,’” she said, describing primary care visits shortened by reimbursement pressures.

Her message to policymakers is blunt. “Everyone should be in one system,” she said, arguing that broad risk pools lower costs and stabilize care. She believes nothing will change until lawmakers experience the same insurance challenges as their constituents. “Until you have more than a $15 copay and a $30 specialist that you don’t pay for, nothing is going to change,” she said.

After decades inside the system and now struggling within it herself, Anne Marie sees the consequences clearly. Rising premiums, high deductibles and complex rules are pushing people away from care and back toward crisis-driven treatment. “Making it unaffordable for health insurance just doesn’t mean that people are going to pay,” she said. “It means they’re not going to get health care.”