Amy Lynn Smith: Living Proof That the ACA Saves Lives

Before the Affordable Care Act (ACA), Amy Lynn Smith of Michigan said she would break into a cold sweat every year when she opened her annual insurance renewal letter. As a self-employed woman with Type 1 diabetes, her premiums were exorbitant – closing in on $1,400 a month in 2013. They were increasing $100 a month every year, and she still had out-of-pocket costs.

“I worried the day would come when I wouldn’t be able to afford insurance any longer,” she said, “which would mean not being able to pay for the insulin I need to stay alive. And after ten years of being able to afford my insurance thanks to the ACA, I’m panicked all over again.”

When the ACA Marketplace opened in the fall of 2013, Amy signed up for a plan that was exactly the same as the plan she’d bought directly through her insurance company. But instead of $1,400 a month, the same plan cost $530 a month, without the help of tax subsidies. Plus, it was even more robust than the original plan, including dental and vision coverage she’d never had before.

“I realize $530 a month is expensive,” she said, “but I’d pay more than that just for insulin without insurance, leaving me unable to see the multiple doctors someone with diabetes needs to stay healthy. Plus, I made the choice to purchase a plan with a higher premium to keep deductibles and out-of-pocket costs low.”

Costs have increased some each year, but even in 2025 she was still paying less than she had been before the ACA, about $1,000 per month for comprehensive coverage. With the economy’s downturn during the year, she qualified for tax subsidies that brought her premiums down to $550 a month, with a lower deductible and out-of-pocket costs.

Republicans in Congress and the Trump Administration have chosen to give tax breaks to the ultra-wealthy at the expense of healthcare subsidies and Medicaid coverage. They’ve been trying to dismantle the ACA since the beginning, and Amy fears they may finally succeed – leaving her unable to afford health insurance or life-sustaining medication.

“Health insurance should not be a for-profit business,” Amy said. “It should be a for-patient business. I don’t have a problem with corporations making money – they have to keep the doors open. But when it comes at the expense of patient health, it’s immoral and dangerous. Potentially millions of people will no longer be able to afford health insurance, and they could die as a result. I dearly hope I’m not one of them.”