MEMORANDUM

To: Interested Parties 

From: Community Catalyst

Date: November 19, 2025

Re: The Voices Washington Needs to Hear Right Now ____________________________________________________________________________

The government has re-opened, but after historic cuts to health care, affordable health care is still slipping out of reach for millions. For people juggling rent, groceries, and lifesaving treatment, this isn’t a political storyline. It’s their everyday reality – and it deserves to be heard. 

Yet too often, these voices are drowned out by the noise of Washington — the polling, the posturing, the daily scorekeeping. What gets lost is what is actually happening on the ground: families facing premium spikes overnight, small business owners bracing for impossible trade-offs, and older adults and people with chronic conditions wondering whether they’ll be able to stay insured next year, afford the life saving care they need, or drown in medical debt. 

This is all unfolding as families head into the holidays and winter months, when higher heating and household costs leave even less room for rising health care bills. And the best way to understand this moment is to listen to the people living it. Their stories cut through the punditry and make the stakes unmistakingly human. 

Through our local, state, and community partnerships, Community Catalyst has a unique, real-time view of how rising costs are affecting people on the ground, the tough decisions people are being forced to make — and how national policies shape those experiences.

Below are short videos and written testimony from people across the country — each one a clear window into what Congress’s inaction means in real time. 

James in Maryland

James Hollywood III is a small business owner and community leader whose experience shows how policy decisions reverberate far beyond individual households. Enhanced premium tax credits don’t just help him afford his own coverage — they stabilize his nonprofit organization, support his employees’ health, and strengthen the families he serves.

“As a small business owner, the Enhanced Premium Tax Credits have made all the difference. They help me keep my own costs manageable and they also help other small business owners, freelancers, and families in my community afford coverage.” 

A man wearing glasses as well as a navy suit, blue tie, and white shirt speaks in a room.
Nancy in Georgia 

“I have brain cancer and seizures since 2006, and now I have Parkinsonism due to brain damage. I can’t work or drive, and my husband is self-employed, so no option for employer health insurance. I have to have him take me to all of my doctor appointments, OT and PT therapies, and anywhere I need to go. We depend on the ACA subsidies. If we don’t have the subsidies, our premium increases from $169 to $2,191.”

Bobby in Maryland

Working multiple jobs in Baltimore’s restaurant and HVAC industries, Bobby doesn’t have access to employer health insurance. He buys his coverage through Maryland’s marketplace — and federal health care tax credits are the only reason it’s affordable.

Before receiving the credits, he was paying for a high-cost plan that covered very little. Specialist visits cost hundreds of dollars, and any emergency threatened to bury him in medical bills. The federal tax credits lowered his premiums to be able to purchase a comprehensive health insurance plan, reduced his deductible by thousands, and made it possible to see doctors without going into debt.

“Previously, I was paying for a higher-cost plan that did not give me much coverage… The federal health care tax credits have given me access to great health care, and I would hate to lose it.”

A man with short blonde hair and a red shirt sits in front of curtains in a living room
Louisa in Rhode Island

“I am an ovarian cancer survivor with several complex chronic medical conditions. Without tax credits, I cannot afford health insurance.”

Gordie in Iowa

“I use the ACA and I get a premium tax credit. I don’t have employer-funded health care and I’m too young to get Medicare. If the ACA tax credits are not extended, I will have to pay for them out of my retirement savings. I just want my savings to last as long as I do. Without the ACA tax credits, my savings will run out much more quickly.”

Querido in California

“My spouse and I are both self-employed creative professionals in our 50s. We rely on the Affordable Care Act for affordable health insurance premiums. Without the extended tax credits we are facing a nearly 1000% increase in those premiums. We simply cannot afford this and will have to go without health insurance—not ideal when you’re in your 50s.”

Anthony in Kansas 

“Without the ACA, I could not get my medication for my mental illness. Without staying [on] my meds, I can’t work and would be homeless.”

What these stories reveal

These experiences underscore a deeper truth: this moment isn’t about individual choices or budgeting decisions — it’s about structural inequities that have pushed affordable health care out of reach for far too many.

Premium spikes and the loss of enhanced premium tax credits hit Black, Latinx, and immigrant families hardest, not because of anything they’ve done, but because decades of policy decisions have limited wages, wealth, economic opportunity, and access to stable coverage.

“When people lose affordable options, the consequences are immediate and predictable: more medical debt, more people pushed into low-value or non-comprehensive plans, and more families steered toward deferred interest medical credit cards that trap them in long-term debt,” shared Mona Shah, Senior Director of Policy and Strategy, Community Catalyst. “Our partners and navigators are seeing this unfold every day — people weighing whether they can stay insured at all, delaying care, or taking on financial risks they know are unsustainable. These are systemic pressures, not individual failures — and they’re preventable.”

Additional Background

A Georgetown Center on Health Insurance Reforms report highlights the reality millions of people face. And it is not a political game. According to the report, if Congress fails to extend the enhanced premium tax credits, people throughout the country will experience the largest health care premium increases in almost a decade, and it will disproportionately hurt those who are older, low- and middle-income, self-employed or living in rural areas. 

According to the non-partisan Congressional Budget Office, if Congress fails to act, premiums could spike by as much as 75%, and more than 4 million people could lose coverage.

The bottom line

These are the voices Washington needs to hear right now. Real people dealing with the consequences of inaction — consequences Congress has the power to prevent.

These documents help us show policymakers what families are up against right now. Together, we can make sure these voices are impossible to ignore.

If you are a journalist and would like to speak to those impacted by Congress’ inaction, or a policy expert at Community Catalyst, please contact Jack Cardinal at jcardinal@communitycatalyst.org.

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