The day after Thanksgiving, I got a voicemail. A woman identified herself as a doctor at the University of Louisville hospital: “I believe I may have one of your family members here.” The message was hard to understand. Most of my family lives in Kentucky, so I didn’t know whom the doctor was referring to. I called the hospital, but kept getting put on hold. Then I tried my aunt—if someone was in trouble, she’d be the one to know. But she didn’t answer. A few hours later, her son got in touch with me. My aunt was the one in the hospital. She’d had an aneurysm on the right side of her brain, and it had burst. The drainage tube the doctors used to stop the bleeding kept slipping loose; after three tries, they finally got it to stick. Only then could they do surgery. My cousin FaceTimed me afterward, from the ICU. “Are you ready?” he asked. He angled the camera down to my aunt’s face, and I started sobbing like a sudden rainstorm. A few days later, I got on a plane from Washington, D.C., to Kentucky and went straight to join my family at the hospital. We had always called my aunt “The Glamourina.” She wore feathered hats with sparkly shirts and experimented with different hairstyles: a butterscotch-blond cropped cut, an afro, a bob streaked with highlights. She paid for my first real manicure, when I was in high school. We wore matching striped shirts to the salon, and used an eyeliner pencil to draw fake moles above our lips, like Marilyn Monroe. She is 58 now, and raised two kids as a single mother. She always treated me like one of her children, and I grew up to look more like her than like my own mom. When I’d talked with her the week before she ended up in the hospital, she’d asked me to play our favorite song, “I’m So Proud of You,” by Julie Anne Vargas. Now the top half of her head was shaved and staples ran in a ladder across it. IVs were taped to each arm, and a machine next to her bed was helping her breathe. She couldn’t speak. When she opened her eyes, they rolled. Her older son was especially alarmed by how quickly she’d declined. He wanted the doctors to come into her room so they could explain what had happened. But one of our older relatives stopped him, saying that we couldn’t afford to make demands, let alone trouble, because “she don’t have a lick of health insurance.” We knew that the hospital couldn’t deny her care, but we understood the tightrope you walk when you don’t have money. All she could afford to be was grateful. We don’t know what caused my aunt’s aneurysm, but she’d had persistent headaches for months, and she’d been worried. Once, when she was driving, the left side of her body turned numb and her toes curled up. She pulled over but didn’t go to the hospital; she couldn’t afford it. My aunt worked as a hair stylist at a salon for years. Most recently, she was the overnight caregiver for an elderly woman, but she had opted out of her employer-sponsored health insurance because she couldn’t afford the premium. She’d occasionally had coverage in the past, but it never guaranteed that she’d actually be able to afford health care. She called me once, defeated, because she was trying to fill a prescription at Walgreens and the pharmacy had flagged an issue with her insurance. She would need to pay out of pocket, and she didn’t have the $134.89. She was often frustrated by spending long spells on hold with insurance agents, and was overwhelmed by the complexity of the plans. [Annie Lowrey: Annoying people to death] My aunt’s experience with the health-care system is familiar to many Americans. In a 2023 survey by the Kaiser Family Foundation, nearly a quarter of adults said signing up for a plan was simply too confusing. Even those who have coverage may decide to delay or skip treatment because they can’t afford the out-of-pocket costs, resulting in emergency-room visits and hospitalizations that could have been prevented. Some years, my aunt made so little money that she might have qualified for Medicaid, but not recently—the income cutoff if you’re single in Kentucky is $1,835 a month. Some years, she bought coverage through the Affordable Care Act’s exchanges, but eventually she decided it was too expensive. Many more people are now making that same decision. In 2025, the Republican-controlled Congress voted to let Biden-era subsidies in the ACA, which had helped some 22 million people afford their coverage, expire. Within just two weeks of the cutoff, at the end of December, enrollment had dropped by 1 million people. According to one group’s estimate, families are paying $200, $300, or $1,000 more a month; many have seen their premiums double. [Read: The coming Obamacare cliff] In January, President Trump released his proposal for a “Great Healthcare Plan,” which suggests that savings from the former subsidies could be sent directly to “eligible” Americans. But who would be eligible? The proposal makes no mention of the many people who don’t have coverage. Then, in February, the Trump administration released a list of 43 prescription drugs that Americans can buy for reduced prices. But some of these were already available at those prices or in generic forms, and they make up a tiny fraction of the drugs Americans need; the prescription my aunt couldn’t afford, for instance, is not listed. Nothing about Trump’s pronouncements changes the fact that millions more Americans will soon be stuck where my aunt was: in the middle—sometimes insured, sometimes uninsured, but always too poor to get the care they need. As I stared at my aunt in the ICU, I noticed that her eyebrows were freshly waxed, and her nails had bleach-white French tips. Only the week before, she’d texted me about getting
