Wayne Riley: Rising Costs Lead to Impossible Choices

For two years, Wayne, a 56 year old living in Colorado with his wife, relied on marketplace insurance to protect their health, and their finances. Their monthly premium of $690 was high but manageable. That all changed when Wayne, a self-employed commercial cleaner, contacted his insurance agent to ask about the upcoming year.

Wayne had heard rumors of rising marketplace premiums, but the reality shocked him. Starting in January, his monthly premium would nearly triple, to $1,993.

Wayne never received a formal notice about this change. He only learned the details after proactively calling his agent. “I heard through the rumblings about the shut down and about how everything’s going up,” he said. When he asked for clarification, his agent confirmed the unbelievable jump.

The consequences for Wayne and his wife are severe. Faced with an unaffordable premium and an $8,000 deductible, he says they are likely to cancel their health insurance and “just pay out-of-pocket.” It is not a choice he wants to make. “I prefer to have insurance,” he said, “but we can’t afford $1,900 a month, that is crazy. That’s with an $8,000 deductible. I’m mad about it.”

Their biggest worry is what would happen if one of them needed hospital care. His wife has diabetes, and while they can often negotiate cash discounts for routine care, major medical needs are another story. “If anybody has to go to the hospital for something major, then you’re bankrupt basically,” Wayne said.

Wayne knows this from experience. After going without insurance for 25 years, he and his wife finally signed up two years ago. During that time, she needed two hip replacements. The coverage protected them from financial catastrophe, even though they still paid thousands out of pocket. “We had to pay our $8,000 deductible every year plus our $690 per month,” he said.

Despite the high costs, Wayne says the previous premium was at least manageable. What they face now is not. “You would expect a five or 10 percent increase on everything just the way life is,” he said. “But not triple.”

When asked what he wishes policymakers understood, Wayne focused on the role of large insurers. “They need to think about all these insurance companies being the biggest trillion-dollar profit companies in the world,” he said. “Healthcare shouldn’t be for profit.” He emphasizes that unlike buying a luxury item, families cannot opt out of needed medical care.

Wayne’s story reflects what many families across the country are now facing. The loss of affordable coverage does not just raise premiums; it forces impossible choices about health, stability, and financial survival.