2026-09-25T10:05:06.268Z / 路透社
- 部分美国人转而选择短期保险计划、医疗互助团体，或是干脆不买医疗保险
- 医院表示，他们接诊的无保险患者越来越多
- 专家警告，替代医保计划可能缺乏对患者的保障措施
9月25日（路透社）——犹他州卡纳布市的自营摄影师斯泰西·考克斯今年放弃了她的奥巴马医改计划后，常规预防保健成了一项财务难题。如今她正纠结于：是花1200美元做乳房X光检查，还是保住自己的生意。
“这太吓人了，”这位49岁的考克斯告诉路透社记者，“每个月我们都要坐下来讨论：是不是该关掉生意了？是不是该找份工作，指望能获得医疗保险？”
考克斯有乳腺癌家族病史，属于高风险人群，还患有自身免疫性疾病，需要定期服药。
她是今年年初因保费和自付额大幅上涨而退出奥巴马医改创建的平价医疗法案（ACA）市场的300万美国人之一。根据政府数据，截至今年2月，这种根据收入提供补贴的医保计划覆盖了1920万人。今年年初新冠疫情期间的强化保费税收抵免政策到期，是保费大幅上涨的原因之一。
考克斯是近十几名告诉路透社记者，他们转而选择保障范围较窄的短期健康计划，或是加入医疗互助项目的美国人之一。在医疗互助项目中，成员每月缴纳分摊金，用于互相支付医疗费用。许多美国人干脆选择不购买医疗保险，而这正是平价医疗法案最初旨在解决的问题。
多家医院运营商已经发出预警，称接诊无保险患者带来了成本上涨，其中包括通用健康服务公司（Universal Health Services）。
总部位于宾夕法尼亚州、拥有500多家医疗机构的UHS.N，其首席执行官在7月份表示，似乎大多数放弃平价医疗法案医保的患者现在都没有保险了。
短期医保的参保数据仍然有限。
美国医疗保险和医疗补助服务中心（CMS）的一位发言人表示，这类计划主要旨在填补临时的医保缺口，比如某人从雇主提供的医保计划过渡期间的空白，是现有可选方案之一。
根据健康政策研究机构KFF的数据，在平价医疗法案市场，保险公司已提议2027年的保费中位数上涨约15%，这将是连续第二年出现两位数的涨幅。
平价医疗法案医保的参保登记时间为11月1日至次年1月15日。联合健康集团（UnitedHealth）UNH.N、安泰保险（Elevance）ELV.N、健保公司（Centene）CNC.N和莫利纳医疗（Molina Healthcare）MOH.N都提供奥巴马医改计划。包括联合健康在内的一些保险公司，也提供短期医保计划。
转向更便宜的选项
来自马里兰州弗雷德里克市的56岁瑞安·夏皮罗计划在今年年底前关闭自己的摄影工作室，帮助妻子经营室内设计生意，部分原因就是医疗费用上涨。
夏皮罗今年放弃了他的平价医疗法案医保，因为他的月保费预计将翻倍至1000多美元。他转而选择了每月约600美元的短期计划，该计划覆盖住院治疗和重大疾病。
根据现行联邦规则，短期医保计划通常期限限制为3个月，外加1个月的续期。但在CMS去年宣布将停止执行该期限后，多个州允许更长的保障期限。
“这是全面医保费用的一半，”夏皮罗说，“这能让我们在发生健康危机时尽量减少开支。”
推迟就医
多名受访人士表示，由于保费和自付额过高，他们推迟或跳过了预防保健、年度体检和其他治疗，必要时才自掏腰包看急诊。
“如果我们其中某个人生病了，该怎么办？”已经跳过常规癌症筛查的考克斯说，“我们只能等死吗？因为我们肯定负担不起治疗费用，这真是一个可怕的处境。”
高额的自付额是另一个痛点，迫使患者在保险覆盖生效前自掏腰包支付数千美元的医疗费用。一些人还表示，他们的医保计划可选择的医生范围很窄。
有些人转而加入医疗互助项目，这类项目通常由宗教团体组织，通常不提供消费者保障。
亚特兰大53岁的公共关系顾问克里斯汀·康奈利今年放弃平价医疗法案计划后，于2025年加入了锡安医疗互助会（Zion HealthShare）。她为自己和成年子女每月支付480美元，其中包括每位家庭成员每年一次的预防性体检、每年一次的乳房X光检查，以及每隔一年一次的结肠镜检查等服务。
她的计划有5000美元的最低提交支出，锡安医疗互助会将其称为“初始不可分摊金额”，也就是个人成员在医疗费用符合社区共享池资格前，必须自行支付的金额，实际上就是自付额。
锡安医疗互助会拥有超过7.8万名活跃成员，没有宗教信仰要求。
“我对保险的体验是，报销流程非常麻烦，他们总是拒绝理赔，然后说只支付一部分费用，”康奈利说，“而我在医疗互助项目中的体验是，无论我要求什么项目的自费价格，都要低得多。”
她说，她希望长期来看能脱离这个医疗互助项目。
专家表示，医疗互助安排和其他非传统医保产品存在重大局限。
乔治城大学健康保险改革研究中心的研究教授萨布丽娜·科莱特表示，许多州没有对激进或欺骗性的营销行为进行充分监管，这让消费者容易受到侵害。
“在这类产品方面，这里真的有点像‘狂野西部’，”科莱特说，“有些是合法的，有些则不那么合法，完全需要买家自行谨慎！”
本报孟加拉uru记者斯里帕娜·罗伊报道；米纳利卡·罗伊、卡罗琳·胡默尔和比尔·伯克罗特编辑
Americans navigate ‘wild West’ of health insurance options after dropping Obamacare plans
2026-09-25T10:05:06.268Z / Reuters
- Some Americans are switching to short-term plans, health-sharing groups or going uninsured
- Hospitals say they are treating more uninsured patients
- Alternative plans can lack protections for patients, experts warn
Sept 25 (Reuters) – When Stacy Cox, a self-employed photographer in Kanab, Utah, dropped her Obamacare health insurance plan this year, routine preventive care became a financial dilemma. Now she finds herself weighing $1,200 for a mammogram against survival of her business.
“It’s scary,” the 49-year-old Cox told Reuters. “Every month we come to the table and we have a discussion. Is it time to close a business? Is it time to seek employment somewhere in the hopes of gaining health insurance?”
Cox is at high risk for breast cancer due to family history and has an autoimmune disease requiring regular medications.
She is among 3 million Americans who dropped out of the Affordable Care Act marketplace, created by President Barack Obama and often called Obamacare, due to sharp increases in premiums and deductibles at the beginning of 2026.
The plans, which offer subsidies based on income, covered 19.2 million people as of February, according to government data. Expiration of enhanced COVID-era premium tax credits at the beginning of the year contributed to sharp cost increases.
Cox is one of nearly a dozen Americans who told Reuters they shifted to skimpy, short-term health plans that provide less comprehensive coverage, or have joined health-sharing programs, where members pool monthly contributions to help pay each other’s medical bills. Many Americans have opted to go without health insurance altogether, a situation that the ACA was originally meant to address.
Several hospital operators have flagged rising costs tied to treating uninsured patients, including Universal Health Services
UHS.N, a Pennsylvania-based hospital system with more than 500 facilities. In July, its CEO said it seemed most patients who had dropped ACA coverage were now uninsured.
Enrollment data on short-term coverage remains limited.
A spokesperson for the US Centers for Medicare & Medicaid Services said these plans, which are primarily designed to help fill a temporary coverage gap, such as when someone is transitioning from an employer-based plan, are one of several options available.
In the ACA marketplace, insurers have proposed a median premium increase of about 15% for 2027, according to health policy research group KFF, marking the second successive year of double-digit hikes.
Enrollment for ACA plans opens November 1 and runs until January 15. UnitedHealth
UNH.N, Elevance
ELV.N, Centene
CNC.N
and Molina Healthcare
MOH.N
offer Obamacare plans. Some insurers, like UnitedHealth, also offer short-term plans.
TURNING TO CHEAPER OPTIONS
Ryan Shapiro, 56, from Frederick, Maryland, plans to wind down his photography business by year end and help his wife run her interior design business, in part due to the rising cost of healthcare.
Shapiro dropped his ACA coverage for this year because his monthly premium was set to more than double to over $1,000. He instead chose a short-term plan that costs roughly $600 a month and covers hospitalization and critical illnesses.
Under current federal rules, short-term plans are generally limited to three months, plus a one-month renewal. After CMS said last year it would stop enforcing that limit, several states allow longer coverage duration.
“It’s half the cost of full-blown health insurance,” Shapiro said. “It’s a way for us to kind of minimize our expenses should a health crisis happen.”
SKIPPING CARE
Several people interviewed said they had postponed or skipped preventive care, annual checkups and other treatment because of high premiums and deductibles, opting to pay out of pocket for urgent care when necessary.
“What do we do if one of us gets sick?” said Cox, who has skipped regular cancer screenings. “Do we just die? Because we sure can’t afford to fight it, and that’s a really scary place to be in.”
High deductibles have been another pain point, forcing patients to pay thousands of dollars out of pocket for medical services before insurance coverage kicks in. Some also said their plans offered a narrow choice of doctors.
Some people have turned to health-sharing programs, often organized by religious groups, that typically do not provide consumer protections.
Cristin Connelly, a 53-year-old public relations consultant in Atlanta, joined Zion HealthShare in 2025 after dropping her ACA plan. She pays $480 a month for herself and her young adult children, which includes an annual preventive doctor’s visit for each family member, one mammogram a year and a colonoscopy every other year, among other services.
Her plan has a minimum spend of $5,000 for submission, a de facto deductible Zion refers to as an initial unshareable amount individual members must pay before medical expenses become eligible for the community sharing pool.
Zion HealthShare, which has more than 78,000 active members, has no religious requirements.
“My experience with insurance is it’s such a hassle to get things paid. They deny claims all the time and then say they’re only paying a portion of it,” said Connelly. Her health-share experience “so far has been that when I ask for a self-pay rate for anything, it’s much less.”
She said she hopes to move off the health share in the long run.
Experts say health-sharing arrangements and other non-traditional products carry significant limitations.
Many states do not adequately police aggressive or deceptive marketing practices, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, leaving consumers vulnerable.
“There really and truly is a bit of a wild, wild West out there with respect to these products,” Corlette said. “Some of them are legit, some of them not so legit, very much buyer beware!”
Reporting by Sriparna Roy in Bengaluru; Editing by Mrinalika Roy, Caroline Humer and Bill Berkrot
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