Millions of soon-to-be uninsured Americans are looking for a ‘plan B’ : Shots

It's time to feed the animals at this site near Nashville. An albino raccoon named Cricket reaches through the wire of his cage to grab an animal cracker, a snack just before dinner.

“The cricket is blind,” said Robert Sorey, who with his wife Emily is trying to open a nonprofit animal shelter. “Many of our animals come to us with problems.”

The Thompson Station menagerie also includes Russian foxes, African porcupines, emus, lynxes and several plump goats.

Soreys love their pets passionately and seem to put the animals' needs before their own.

Both Robert and Emily will start 2026 without health insurance.

Robert was insured under a marketplace plan subsidized through the Affordable Care Act marketplace. His share of monthly bonuses? Zero dollars.

When he looked at the 2026 rates, he saw that the simple Bronze plan would cost him at least $70 a month. He decided to give up lighting altogether.

“When you don't have any income, it doesn't matter how cheap it is,” he said. “It's unaffordable.”

Dumping coating

Market-based plans under the Affordable Care Act no longer seem affordable to many people because Congress did not extend a package of expanded subsidies that are set to expire this month. Estimated 4.8 million they are expected to remain uncovered.

But even without a health insurance plan, people will still need medical care. Many of them, like Sorey, are thinking through their “Plan B” to maintain their health.

Both Soreys lost their jobs within days of each other in November. Robert worked as a farm laborer. Emily worked for a staffing firm and lost her insurance along with her position.

“It’s a terrible, terrible market right now. Really hard,” she said.

The first time she had to pay out of pocket for three monthly prescriptions, it cost $184.

“To equate it to the way we think about it, you're talking about 350 pounds of food for these animals,” Robert said. He pointed to his lynxes, who only eat meat.

Planning workarounds for the recently uninsured

To keep food in their food bowls, the Soreys are preparing for an uninsured future. They both see the same psychiatrist and have met with him. He said he was willing to work with them, charging $125 per visit. They will have to come back every three months to keep their prescriptions current.

What if other health problems arise? They hope for the best.

“Thank God I’m not one of those people who gets sick very often,” Robert said. “And if I do that, I usually go to the emergency room where they will bill me later and I can get an appointment. [re-payment] plan.”

Emily has serious health problems and has already incurred significant medical debt.

“It’s just sitting there and I saved up the money,” she said. “But I had to go to the doctor.”

Donated medications and sliding scales

There are hospitals and clinics fastening for an influx of new uninsured patients. They're also concerned that people won't know about alternative ways to get health care.

“We don't have money for marketing, so you won't see big billboards or radio ads,” said Katina Bird, the company's CEO. Matthew Walker Comprehensive Medical Center in Nashville, Tennessee. It is one of 1,400 Federally Qualified Health Centers (FQHCs) in the country.

FQHC is partially funded federal government. While they don't typically offer free care, their fees tend to be lower or vary on a sliding scale.

“They’ll probably get the 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 partnerships with Dispensary of Hopeis a Nashville-based nonprofit.

Many hospital pharmacies also work with a non-profit organization that distributed medicine donated by pharmaceutical companies to 277 sites in 38 states.

participating pharmacies must make the drug available free of charge to people without insurance whose annual income is below 300% of the federal poverty threshold.

The organization primarily purchases medications to treat 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 design and engage with our manufacturers and ask them, 'Are you willing to help support this future status that we expect?' – he said. “In general,” he said, drug companies have said they are willing to step up their efforts.

“Their strategy, their position, what their worldview looks like is always up for debate. So we have an ongoing conversation,” Cornwell said.

Ten States Still Have a Medicaid Gap

Hospitals will also have to find a way to provide care to more patients who cannot pay. Industry groups such as Federation of American Hospitals have been vocal about the threat to hospitals' financial health and have called on Congress to expand expanded subsidies, which come in the form of tax breaks.

The impact may be most acute in states such as Tennessee, which have not expanded Medicaid to cover people who work but do not receive job-based insurance and cannot afford it.

Ten states have decided not to expand Medicaid to uninsured low-income adults, an additional provision of the ACA that is largely paid for with federal funds.

This Medicaid gap expected Uninsured rates will jump as much as 65% in Mississippi and 50% in South Carolina, according to the Urban Institute.

Petting one of her Russian foxes, Emily Sorey admits that she is well aware that she will soon become part of this unfortunate and growing population. After all, her last job was in the medical workforce. Her mother is a nurse.

“I understand the system. And I understand that it is people like me who don't pay their bills that are the reason she is suffering. And I feel bad,” she said. “But at the same time, I don’t have the money to pay it.”

This story comes from NPR's health reporting partnership with Nashville Public Radio And KFF health news.