Darlene W.: A Retired Teacher Fears Losing the Coverage That Keeps Her Healthy

After more than three decades in the classroom, Darlene W. thought she had done everything right. She built a career teaching in a small rural public school in New York State, retired with a pension, and found affordable health care coverage through the Affordable Care Act (ACA) Marketplace. For the past two years, she’s relied on that coverage for peace of mind in retirement. But now, with federal subsidies under threat, that sense of security is unraveling. “It’s just made me a bundle of nerves these past few months, worrying about what’s going to happen and if I’m going to be able to afford to continue to stay retired,” she said.

When Darlene retired in 2021, she was grateful for the pension she earned after a lifetime of public service. “It’s one of the things that we do as teachers,” she explained. “We sacrifice yearly pay because teachers, as you know, aren’t very well paid.” Her school district offered an incentive that allowed her to stay on its insurance plan for two years after retiring. But once that coverage ended, she needed a new plan.

That plan, offered through Fidelis Care, fit comfortably into Darlene’s monthly budget. “I was eternally grateful that I was able to get into a plan that was relatively good health insurance and affordable,” she said. “I’ve been on that plan now for two years, and both times renewing it went smoothly.”

The premiums rose slightly over time, but Darlene didn’t worry until she heard that lawmakers were considering rolling back the ACA’s enhanced premium tax credits. When she looked more closely at her plan, the numbers shocked her. “I realized these subsidies are more than what I pay in premiums,” she said. “If I no longer have that subsidy, it will more than double, it’ll be about two and a half times as much. We’re talking 17% of my pension income going toward health insurance.”

Darlene lives on a fixed income and, as a widow, supports herself on one income. She noted that this increase far exceeds the recommended amount of income to spend on health insurance. “I do research and I find that all of the advice out there says a reasonable price to pay for health insurance coverage is between five and 9 % of your monthly income. Mines going up to 17 %.” She’s also worried about her daughter, who buys coverage through the same marketplace. “Her employer and her husband’s employer do not offer health insurance, so she and her husband both are on the marketplace,” she said. “And hers are going to go through the roof.”

Darlene has considered her options if her premiums rise. “My immediate reaction, of course, is work more,” she said. “I live in a rural community. They really don’t pay that great. I would pretty much have to work as a half-time employee. I can pick up some part-time work, but I shouldn’t have to.”

Although she has a small retirement fund, she’s hesitant to draw from it. “I do have a little tiny nest egg, but I don’t want to deplete that,” she said. “I’m still relatively young. I’ll be 60 in January, so Lord willing, I have several years to go. If I start taking it out, $300–$400 a month, that’s going to be gone. Then where will I be?”

Darlene’s story highlights what’s at stake for millions of Americans if the ACA’s enhanced subsidies expire. For retirees like her, especially those who fall between Medicare eligibility and the workforce, these subsidies can mean the difference between financial security and hardship.

She has a message for lawmakers who are debating whether to extend them: “I think that these policymakers really need to stop forgetting about regular ordinary citizens in this country,” she said. “Members of Congress and the Senate get wonderful health care, and I think they need to get more in touch with the real everyday ordinary citizens in this country who are having to struggle and pay for every little bit.”

Even with her current plan, Darlene still faces significant costs. “I’ve been very fortunate. I’ve been happy so far with what Fidelis has covered, but still even under that insurance I’m paying anywhere from $25 to $150 co-pays for every doctor visit,” she said.

After 33 and a half years of shaping young minds, Darlene believes teachers, and working Americans more broadly, deserve better. “There wouldn’t be any lawyers, there wouldn’t be any doctors, there wouldn’t be any senators if it weren’t for teachers,” she said. “We need to make bigger and better investments in our children and our teachers because they are the future of this country.”

Now, she worries that the system she dedicated her life to serving is failing her in retirement. “I put 33 and a half years of my life into my students, my school, and my community,” she said. “I feel like the trade-off we make as teachers for the lower pay is that when you get to a retirement age and you’ve put in 30 or 40 years, you can enjoy your life a little.”

But with her coverage at risk, that promise feels out of reach. “I shouldn’t have to worry about whether I can stay retired,” she said.