Cathy Thomas had been paying $390 per month for health insurance. In January, that premium jumps to more than $1,000. The retired executive assistant from Olathe, Kansas, has lung cancer. She needs regular surveillance. Dropping coverage is not an option. “I have no choice,” she said.
Neither do thousands of other women across Missouri and Kansas who watched enhanced premium subsidies expire on Dec. 31, 2025, leaving them scrambling to afford insurance or going without. At the same moment, the Trump administration systematically dismantled Title X family planning funding, withholding $8.5 million from clinics in Missouri and Oklahoma that are part of the Planned Parenthood Great Plains network serving both states.
This is not policy. This is punishment.
In Missouri, 94% of marketplace enrollees received subsidies in 2025, saving an average of $564 monthly. That help vanished on Jan. 1, 2026. Premiums increased as much as 30% before factoring in subsidy losses, according to the Missouri Independent. Across the state line in Kansas, women face premium increases up to 34%.
The numbers sound abstract until you meet the women doing the math.
Laura Mead is 60, self-employed, and facing what she called her first real prospect of going without health care in her adult life. She currently pays $1,100 monthly through the Affordable Care Act marketplace. The actual premium is $1,427. Enhanced subsidies covered the $327 difference. Without them, she expects her costs to double to $2,000 monthly.
“For the first time in my adult life, I’m facing a real serious prospect of not having health care,” Mead said.
She called her congressional representative’s office looking for answers. The staff person told her they were “trying to get people who aren’t working off those programs.” Mead is working. She is self-employed. The ACA marketplace exists precisely for people like her.
Carolyn McKee, a small business owner in Holton, Kansas, posted on Facebook that her Blue Cross Blue Shield plan would increase by $700 monthly. Within an hour, more than 40 people commented that their rates were doubling as well.
Eileen Spickler of Ottawa, Kansas, testified before a U.S. Senate subcommittee about her husband Barry’s unexpected early retirement and health struggles. For the first time in their lives, the couple turned to food pantries because groceries no longer fit their budget after paying for health care. Her testimony went viral with comments flooding in.
Soon after the subsidies expired, both Missouri and Kansas saw enrollment decline during the first month people could sign up for 2026 plans, even as national enrollment ticked slightly upward, according to data from the Centers for Medicare and Medicaid Services reported by CNN. When insurance becomes unaffordable, people stop buying it. Some will return if they get sick enough. Most will just pray they do not.
In 2025, Missouri had 417,000 people enrolled in marketplace plans. Kansas had more than 200,000. Together, that is 617,000 people facing dramatically higher costs or losing coverage entirely. The Kansas Health Institute predicted Kansas enrollment could immediately return to 2021 levels and uninsured rates could “greatly increase.”
The picture sharpens when you examine who gets hit hardest. Nearly half of all adults under 65 enrolled in marketplace plans are self-employed, small business owners, or work for small businesses with fewer than 25 employees, according to KFF. These are women running their own businesses, freelancers, gig workers, people cobbling together part-time jobs that never offer benefits. An estimated 27% of farmers get health insurance through the marketplace. The economy runs on their labor while refusing to ensure their health.
Brian Colby, vice president of public policy at the Missouri Budget Project, says when people lose coverage, they delay care until conditions become emergencies, straining hospitals and pushing rates even higher for everyone. “There are flaws in our insurance markets that put people in this situation,” he said. “That’s the truth of the matter, and you don’t hear that from Washington. It’s a blame game.”
The Math That Destroys Lives
The enhanced premium tax credits, first introduced in 2021 and extended through 2025, made marketplace insurance accessible by capping premiums at 8.5% of income and eliminating the cliff that cut off help for anyone earning more than $62,600 individually or $128,600 for a family of four.
According to the Kaiser Family Foundation, premiums will more than double on average, jumping from $888 annually to $1,904. But averages obscure the reality. A 60-year-old earning $64,000 will pay approximately $14,900 in annual premiums. That same person earning $2,000 less still qualifies for subsidies and pays about $6,200. One dollar determines whether health care is affordable or impossible.
Women do not get to opt out of this crisis. They use more health care because their bodies require it:pregnancy, contraception, cancer screenings, and preventive care that keep them alive and able to work. According to Elizabeth Tobin-Tyler, a professor at Brown University School of Public Health, women also shoulder what researchers call the mental load: they are the ones figuring out family insurance puzzles, making the appointments, managing the medications, deciding who gets care and who goes without.
This is the landscape women navigate in 2026: raiding retirement accounts, choosing between rent and insurance, or simply going without and hoping for the best. When B., a Providence, Rhode Island, nonprofit manager who asked not to be identified for employment reasons, lost her job last spring, she pulled $12,000 from retirement savings to cover 2025 premiums. Facing a family plan that would cost nearly $3,000 monthly in 2026: “I don’t have an additional $900 lying around in my family budget to pay for this.”
Cynthia Freeman, a Brooklyn freelancer, saw her marketplace premium jump 75%. To afford insurance for her husband’s kidney disease, Freeman took a part-time bartending gig at a bar. At 60: “It’s one thing to have it as a little side gig. It’s another thing to be looking at going into my 60s, and the best choice for me is getting a corporate job as a bartender at a hotel.”
Kathy and Jeffrey Many of Brandon, Vermont, dropped coverage entirely when their premium jumped from $625 monthly to nearly $2,670. “Every time Jeffrey leaves to go out on a job, I’m going to be like ‘Jesus Christ, I hope nothing happens to him today,'” Kathy said, her voice breaking.
Women in their 40s, 50s, and 60s face their own crisis. Without insurance, hormone replacement therapy costs hundreds of dollars monthly out of pocket. Annual mammograms, bone density scans, cardiovascular screenings—the preventive care that catches cancers early and manages chronic conditions—become unaffordable luxuries. Many lose access to gynecologists entirely. These are women who need consistent medical care, who cannot afford gaps in coverage, and who are managing perimenopause or menopause symptoms that affect their ability to work and live. They are invisible in the political rhetoric about reproductive health, but they are drowning in these premium increases, too.
Approximately 9.3 million nonelderly women were uninsured in 2023. That rate was lower than the 13% rate for men, but only because women’s lower average incomes made them more likely to qualify for Medicaid. The enhanced subsidies provided a bridge for women who earned too much for Medicaid but not enough for full-price premiums. That bridge burned Dec. 31.
Title X: A Second Blow
While women across the Great Plains scramble to afford insurance, the Trump administration dealt a second blow: withholding Title X family planning funds.
In March 2025, the administration froze nearly $8.5 million to the regional network serving Missouri and Oklahoma, affecting 52 Missouri clinics, including health departments, community health centers, and seven Planned Parenthood locations, according to the Missouri Family Health Council. The justification: alleged diversity and equity violations.
Title X is the only federal program dedicated solely to family planning services—contraception, cancer screenings, STI testing. For many women, these clinics represent their only access to a doctor. Missouri clinics served nearly 35,000 patients through Title X in 2024, 45% of them uninsured.
Zachary Moser, administrator at Dent County Health Center, told the Missouri Independent that his clinic redirected general revenues to continue offering services free of charge. “Will we be able to do that indefinitely?” he asked. “No.”
Without Title X funding, patients face $1,000 out-of-pocket costs for an IUD or must choose less effective options. Missouri and Mississippi now have no Title X funding at all. Trump’s fiscal 2026 budget proposes eliminating the program entirely.
The Compounding Crisis
The picture only darkens. The 2025 Budget Reconciliation Law blocks federal Medicaid payments for one year to clinics that offer both abortion and family planning services, targeting Planned Parenthood clinics nationwide. The Congressional Budget Office projects this will add 10 million more uninsured over the next decade. The ACA subsidy expiration could add millions more.
The Commonwealth Fund projects these combined cuts threaten up to 55% of Title X health center revenue. Without Title X’s 17% of funding and Medicaid’s 38% of reimbursements, clinics cannot keep their doors open. More uninsured people need Title X clinics. Those clinics are closing.
Missouri Senator Josh Hawley was one of only four Republicans who voted with Democrats on December 11 to extend the subsidies for three years. The measure failed. On Dec. 18, the House voted to support a discharge petition forcing a vote in January on a three-year extension. Four House Republicans broke with leadership to make it happen. But the measure faces long odds in the Senate.
Before the ACA, insurance companies could legally deny coverage for preexisting conditions, including pregnancy and breast cancer. They charged women up to 1.5 times more than men for identical coverage. The ACA ended those practices. But protections do not matter if women cannot afford premiums.
These are not abstract debates. They manifest in Thomas facing $1,000 monthly premiums after cancer. In Mead, contemplating going without coverage. In B., raiding retirement accounts. In Freeman, bartending at 60. In Many, worrying every time her husband leaves for work.
The safety net has not disappeared, yet. Original ACA subsidies remain. Medicaid covers the poorest. But the gap has widened dramatically, and women are falling through it.
Women across income levels will pay more, receive less, and face harder choices. Some will forgo coverage. Some will drain savings. Some will delay care until minor conditions become crises. Some will die.
All in a country with the resources and regulatory framework to ensure access to care, but legislators have opted against prioritizing that access. We live in a country where being female has become prohibitively expensive, where reproductive health care is treated as optional, and where women’s bodies are simultaneously controlled and abandoned.
That is the story of women’s health care coverage in 2026: not the absence of solutions but the refusal to implement them. Not policy failure but deliberate harm.
