I’ve always been interested in public health and access to health care, but my interest isn’t purely academic. One of the reasons my husband stayed in the Navy for 20 years is that we have a son with autism, and he requires a lot of health care, including prescription medications, physical, occupational, speech, and behavioral therapy, and annual visits to specialists. We need affordable health care and the guarantee that everything our son requires is covered.

This personal reality influences my perspective on health care data, as I see families like mine behind the numbers and the decisions our households face.

With enhanced Affordable Care Act (ACA) subsidies expiring at the end of 2025, we conducted a nationwide survey of AmeriSpeak^® panelists between December 18 and December 21 to understand how they were navigating health insurance decisions for 2026. When developing the survey questions, I followed my research interests in access to health care and the effects of ending ACA subsidies.

Our survey reveals a gender divide. Women are significantly more likely than men to say they are extremely or very worried about health care-related expenses, including:  

• Out-of-pocket costs (37 percent of women vs. 25 percent of men)
• Unexpected medical bills (36 percent of women vs. 27 percent of men)
• Monthly health insurance premiums (30 percent of women vs. 21 percent of men)
• Prescription drug costs (27 percent of women vs. 20 percent of men)

Worrying about medical costs is only part of the story. Increases in health care costs mean individuals and families will have to make other financial choices, and women are more likely than men to say it will strain their household finances. While overall 70 percent of adults expect their 2026 health care expenses to create either a major or minor financial strain on their household, 77 percent of women, compared to 62 percent of men, feel this way.

The day after I reviewed the survey data, I heard a news story that said, “Women tend to be the medical decision-makers for the family…especially for the children,” and I thought of families like mine. What does it mean when a mother has to choose a lower-priced plan with a higher deductible?

Maybe it means she can’t go out to dinner with her family and must cook dinner at home. Is that a day when she has to make time to go to the grocery store and prepare dinner? Is that a night that she doesn’t get a break she desperately needs? If she’s a single mother, her husband works the night shift, or her husband is in the military and is deployed, she might not have someone else at home to help, and that break is even more important.

The choices women say they will make because of health care costs in 2026 are telling. Women are significantly more likely than men to say they are very or extremely likely to:

• Cut back on leisure or social activities (36 percent of women vs. 23 percent of men)
• Reduce spending on food quality or variety (29 percent of women vs. 17 percent of men)
• Delay home maintenance or repairs (27 percent of women vs. 19 percent of men)
• Take on additional work or work more hours (25 percent of women vs. 13 percent of men)

What happens when you or a family member receives an unexpected diagnosis? What would you do if you had switched to a plan with high deductibles and fewer covered services because you could not afford the better coverage without the premium subsidy? Will you delay needed care, be at risk for medical debt, or withdraw funds from a retirement account to cover the costs of necessary treatment and services?

The financial pressure is widespread. Among individuals who pay premiums, 71 percent reported increases during the 2026 open enrollment period. This includes 66 percent of households with incomes between $30,000 and $59,000, 73 percent of adults ages 30 to 44, and 78 percent of adults ages 45 to 59.

What’s striking is that, despite these increases, 74 percent of adults facing higher premiums say they’re not planning to change their health plan. People might feel locked in their current coverage despite the higher costs, a decision that reflects both the importance of maintaining health care access and the limited options available.

Women rely more on health care services than men. They use more health care services, partly due to reproductive health needs, and they are more likely than men to have multiple chronic diseases. In addition, insurance coverage is associated with appropriate outpatient care and routine monitoring. Having health insurance increases women’s use of mammograms and colon cancer screenings, and for maternal health, coverage is associated with increased access to prenatal and postpartum care.

As enhanced ACA subsidies expire, these improved outcomes may be at risk. The data reveal that women face substantially greater financial concerns from rising health care costs, which might be rooted in their higher health care use and expenses. Given women’s greater reliance on health care services, policy changes that increase costs have disproportionate impacts on women’s financial security and health access.

I hope organizations working on health care policy and women’s issues will see what I see in these data: a need for deeper investigation. Monitoring how these gender-based patterns evolve will be essential for understanding the relationship between policy changes, coverage decisions, and health outcomes. Behind every percentage point in these data are real families making difficult choices between health care and other basic needs.