Late last month, Elizabeth Wick got the email she had been dreading. Her insurer, Blue Cross and Blue Shield of Texas, told her that the monthly premiums for her Affordable Care Act policy would soar to $1,380 next year, up from $862.

Wick, 57, currently gets $400 in federal premium subsidies, which makes the monthly cost of her health insurance more manageable. But the Arlington, Texas, resident is not counting on that assistance for next year since she also received a letter from the federal Obamacare exchange saying she likely won’t be eligible for any help in 2026 if the enhanced subsidies expire as scheduled at year’s end.

The rising health insurance rates and lapsing subsidies could upend Wick’s life. A therapist who focuses on sexual assault survivors, she launched a full-time private practice earlier this year but depends on Obamacare coverage since she has preexisting medical conditions. However, having to pay three times her current tab is unaffordable and could force her to give up her practice and find a job that offers health benefits.

“Health insurance will determine what my life will look like, whether or not I can continue with my private practice,” said Wick, who ruminates over the situation before she goes to sleep and when she’s out for her daily walks.

Agonizing tradeoffs

Wick is among the millions of Americans with Affordable Care Act policies who must contend with the looming lapse of the enhanced subsidies. The increased cost of coverage can lead to agonizing trade-offs for many enrollees, including cutting back on o