When Jake Calderon first started buying his own health insurance at 26, he mostly cared about keeping his monthly premium low. He was a runner, went to the gym a lot, had always been healthy, and while he knew he needed insurance — that he’d be “screwed without it” — he figured a basic plan was fine since he mostly just used it for a physical once a year. “I never thought that, ‘Hey, you're going to be straddled with major health concerns,’” said Calderon, who’s now 32 and lives in Indianapolis, Indiana.So he took the extra money his six-person accounting firm gave him to buy his own insurance on the Affordable Care Act marketplace, and picked one of the cheapest plans he could find: a Bronze plan with a reasonably low premium of about $285 a month when he first signed up in 2020.He was more excited that the plan included a free gym membership than he was concerned about the possibility of ever having to pay its $7,700 deductible. But then this past February, he slipped on some ice.His back hurt, but he said, “my motto is always to avoid going to emergency services because I don't want to have to pay.” So he waited. The pain kept getting worse. Then about ten days after he slipped, Calderon also started losing feeling in his thighs, groin, and glutes. He called his mom, who told him to call the hospital, where someone told him to go to the emergency room. An MRI showed he had a herniated disk crushing his nerves.“Several hours later, they were dressing me and prepping me for surgery,” he said. “And then in the middle of that night, I got the herniated disc removed, and I've been recovering since.”He’ll now have to do the thing he was trying to avoid by waiting to go to the doctor: pay his entire deductible, which this year rose to $10,600. Health insurance costs have been rising across the board. Much of the attention has been on premiums, which spiked this year for people who get coverage through the ACA marketplace, after Congress chose not to renew the pandemic-era subsidies that made buying a plan more affordable for millions of people. But deductibles have been rising, too — that’s the amount you have to pay out of pocket before your insurance starts covering anything beyond preventive care.The average deductible for an ACA plan in 2026 is nearly $4,000 a person, a thousand dollars more than it was last year, according to a recent analysis from the health policy nonprofit KFF. The main reason the average ACA deductible jumped much higher this year is that, when the enhanced subsidies expired, about 25% of people switched to plans with lower monthly premiums.“But lower premium plans come with higher deductibles,” said Sara Collins, a senior scholar at the Commonwealth Fund. “So it means that people are trying to save money up front by lowering their premium costs and enrolling in plans that will have much higher deductibles.”And then feeling like they can’t afford to actually use their insurance. “When the ACA was being signed, the big conversation was, ‘Do you or do you not have insurance?’ Just yes or no,” said Lindsay Allen, a health economist at Northwestern University. “However, we have not been paying a lot of attention to what's been happening within that ‘yes I am insured’ category over the past couple of decades.” Which is that a growing number of people, about 25%, are underinsured. “That means you have insurance, but the cost barrier is still too high for you to be able to actually use your insurance as intended,” Allen said. Of those who are underinsured, a recent survey from the Commonwealth Fund found nearly 60% said they have put off needed healthcare because it was too expensive. Of those, about 40% said they had a health problem get worse because they delayed care.“We really need to have a hard conversation about the role of deductibles in health benefits,” Collins said. Deductibles were originally intended to discourage people from going out and getting lots of expensive, unnecessary tests and procedures, and to incentivize them to shop around. But shopping around for better prices in health care is challenging; despite a 2021 law requiring hospitals be more transparent about pricing, most still aren’t. “What we found over time is that [deductibles have] not only failed to encourage shopping, but they've acted as an affordability barrier to all care,” Collins said. And for people with chronic health conditions, “deductibles really act as an intrinsic tax,” she said. “They just have to pay a lot more out of pocket to get care to stay healthy during the year.”Deductibles have been rising for the same reason premiums have — healthcare is getting more expensive, and insurers want consumers to share the cost. But sharing so much of the cost is feeling increasingly untenable for many people. In a recent KFF poll, nearly two-thirds of adults said they were worried about being able to afford healthcare, beating out most other economic concerns; nearly 90% said healthcare costs will affect how they vote in the midterms in November. Five years ago, Jake Calderon’s premium for a Bronze ACA plan in Indianapolis was about $285 a month and his deductible was $7,700; today that premium for that same plan is about $425 a month and the deductible is $10,600. “I don't know how people can afford this,” he said. After his back surgery this spring, he’s now on a plan with the hospital to pay $216 a month for the next four years. That’s how long it’ll take him to pay off that $10,600. “I thought I was doing pretty well for myself, and now I'm in such a money crunch,” he said. “I'm utilizing credit just for normal expenses, and I just don't see a bright future where I'm able to afford the lifestyle I was living, and continue to make these payments.Especially if his insurance premium and deductible go up again next year, which he’s expecting they will.