AUGUST 1, 2026

Medical debt rises as ACA subsidy expiration, OBBBA Medicaid cuts, and congressional inaction leave patients and providers under strain

Medical debt in the United States is increasing as a combination of factors — including the expiration of Affordable Care Act tax credits, the passage of the One Big Beautiful Bill Act (OBBBA), and rising deductibles — leaves more Americans either uninsured or underinsured. The OBBBA, signed into law by President Trump on July 4, 2025, cut nearly $1 trillion from Medicaid, imposed stricter enrollment rules, and reduced hospital funding. Kaiser Family Foundation data cited in coverage indicates roughly half of U.S. adults say they could not cover an unexpected $500 medical bill without going into debt.

The Washington Examiner's reporting drew on a range of healthcare industry and policy sources to describe a patient debt crisis worsening across several fronts simultaneously. The piece led with the intersection of structural market problems and recent policy changes, noting that even insured Americans are increasingly exposed to financial hardship through high-deductible, low-premium plan designs.

Jack Glasker, owner of New Jersey-based brokerage Affordable Health Care Solutions, described the dynamic as benefit plans being given greater freedom to shift cost-sharing onto consumers through higher deductibles and maximum out-of-pocket limits. He said this trend, combined with decreased ACA subsidies, is "the leading cause of rising patient medical debt."

The OBBBA, described by Republicans as delivering core conservative promises — including permanent tax cuts, an expanded child tax credit, and exemptions on tips, overtime, and auto loan interest — drew criticism from healthcare providers for its Medicaid reductions. Rene Hermes, chief operations officer of a Chicago-based family medicine clinic, said the law's changes "left many on the sidelines," with up to one-third of patients reportedly delaying or canceling treatments due to financial stress.