East Lansing resident Mary Cusack went off the health insurance “subsidy cliff” at the beginning of 2026.
Now, almost a year later, she remains in a freefall.
After Congress let certain premium tax credits expire under the Affordable Care Act, Cusack’s monthly premium rose from $313 a month to $828 a month.
If she sticks with the same plan next year, she will have to pay $1,181 a month — a 277% increase in just two years. That would represent almost 22% of her $65,000 annual income.
“It’s devastating,” Cusack said.
Cusack’s situation is a textbook example of the so-called subsidy cliff, a term coined to describe what some middle-income earners have faced since the elimination of enhanced subsidies. Before Congress let them lapse at the end of 2025, people earning more than four times the federal poverty level of $15,960 could still receive subsidies. At $65,000, Cusack is now just $1,160 above the income limit for a subsidy.
“While virtually all subsidized enrollees will pay more,” Shameek Rakshit, a research associate with the nonpartisan policy health organization KFF, wrote in October 2025, “older middle-income ACA enrollees will see the largest dollar increases in premium payments due to the return of the ‘subsidy cliff.’”
That describes Cusack. She is 58. She is single. She is one of an estimated 4-5% of ACA enrollees who lost their subsidies.
Before the pandemic hit, Cusack was dean of Mott Community College in Flint where she says she had a "great salary" and a "great package" of benefits like health insurance.
But during the pandemic, classes and administration went online which she disliked.
As dean, she dealt with Mott’s Higher Education in Prison program, so she offered to take charge of it and give up the deanship.
The institution agreed, but it could only afford to do so if she became a contractor and gave up her benefits. Four years later, Mott still has not funded the job as a full-time staff position.
That led her to the ACA’s Marketplace for health insurance.
“I’m a cancer survivor, so I feel like I have to have insurance in case it ever comes back,” Cusack explained. She found a Blue Cross Blue Shield Michigan plan two years ago with a $313 a month premium and a $9,200 deductible.
Then the subsidy disappeared. The same plan would have cost her $1,000 a month this year without the tax credits, she said. Instead, she opted for a lesser plan at $828 a month and an even higher deductible.
She has barely used her coverage this year. She had an annual checkup. She had a mammogram. She had vaccinations.
That same plan will cost $1,181 a month starting Jan. 1, with an $11,000 deductible.
She feels like she is “just paying for nothing."
"You’re just paying for it in case something happens," she said.
She understands she is part of a pool, which means healthy people are sharing in paying everyone’s medical costs. Still, it’s frustrating.
Bill Tuthill is a vice president for Blue Cross Blue Shield Michigan, the biggest health insurance provider in mid-Michigan.
He assessed Cusack’s situation as: “She can get coverage,” referencing the era before the Affordable Care Act when having a pre-existing condition such as cancer would have been an obstacle.
“The problem is it is not affordable,” he said.
“It’s a hole in the public health safety net,” Tuthill said. “We have an imperfect approach across our patchwork of government programs.”
He called Cusack's case an "acute" one, where people like her "are decidedly middle income but priced out of the care that they think they need.”
Sandy Fester, a vice president for BCBSM’s small group sales, said employers are passing along premium increases.
"We know those premium increases are not affordable, and while we’re making improvements and progress with lower rate increases in 2027, it’s still not enough.”
The rate increases the state approved for Blue Cross for next year are roughly half of what it was granted for this year. The 2027 rates will increase 11.9% or 12.8%, depending on which type of pool you choose. But what an individual will actually pay varies widely based on a variety of factors, including eligibility for an ACA subsidy.
When BCBSM announced its proposed rate increases for the new year, its press release said the company was “continuing to advocate for solutions that improve long-term affordability.”
Asked for examples, Tuthill cited the shift from “extremely expensive brand-name” prescriptions to generic versions. Another, he said, was encouraging people “to utilize the healthcare system in an efficient way” by, for example, seeing a primary care physician or going to urgent care instead of the “very expensive” emergency room.
Fester added that BCBSM has been “very thoughtful” on keeping administrative costs down.
Cusack had wondered if BCBSM, which is a nonprofit, makes money. Its filings say the opposite: It incurred a $246 million operating loss in 2025. Fester points out that for every $1 Blue Cross takes in, it spends $1.02. However, with over $5.7 billion in reserves, it can absorb that kind of a hit.
Still, Fester said she understands that is little comfort to Cusack and the hundreds of thousands of Michiganders facing rate increases regardless of which company insures them.
“We know the premiums are not affordable, and while we’re making improvements and progress with lower rate increases in 2027, it’s still not enough," she said.
But what is enough, especially in light of midterm elections in which local and statewide voters chose advocates of “Medicare for All” in sending William Lawrence and Abdul El-Sayed to Congress?
Here, a BCBSM spokesperson jumped into the conversation.
“I can probably take this one,” said Gabriella Abel, who arranged the joint interview with Tuthill and Fester, suggesting a possible grenade had been thrown into the mix.
Blue Cross believes “truly that everyone should have access to affordable, high-quality healthcare,” she said, speaking for the only health insurance company that is in all 83 Michigan counties.
“While people are really starting to have that conversation, especially with the recent midterm elections,” she added. “We have strong concerns with any public policy proposals that would increase costs, limit choice, or decrease the quality while impeding medical innovation, and that would eliminate the benefits of employer-sponsored coverage."
“That’s all we really have to say on that particular piece.”
In October, Attorney General Dana Nessel filed a lawsuit against BSBCM alleging an illegal health insurance monopoly in the state.
The filing claims the organization worked with Blue Cross Blue Shield Association companies in other states to keep competition out.
A 2025 American Medical Association study found BCBSM controlled around 65% of the state’s healthcare insurance market. That was among the highest market concentrations in the country.
In response to the lawsuit, a statement from BCBSM said the company was "blindsided" and that it "fundamentally disagrees with the Attorney General’s characterization of an uncompetitive insurance market in Michigan."
Incoming Attorney General-elect Eli Savit will have to decide whether he wants to continue pursuing legal action against BCBSM when Nessel's term ends.
Where does that leave Cusack?
Her initial reaction to the dramatic rate increase notice for 2027 was to post on Facebook: “Bye, Bye, Blue Cross.”
But since then, she has done some research and was considering another Blue Cross plan with a $964 a month premium and an $11,000 deductible. She is trying to determine if other differences that seem minor really are.
If she signs up for that, she will lower her annual expense to $11,568, which would be nearly 18% of her income, instead of 22%.
“The other non-BCBSM plans have lower consumer ratings, so I have a feeling I’ll stick to BCBSM but will drop down to the slightly cheaper plan,” she said.
“It’s throwing good money after bad, since I haven’t had a major issue nor met my deductible in years,” she added.
“But as a cancer survivor, I’m afraid to not have a plan.”