Americans are struggling with healthcare costs. It may worsen.

Organizations that help individuals cover medical expenses report a sharp rise in demand for assistance. The increase is appearing even before potential cuts to Medicaid under President Donald Trump's One Big Beautiful Bill Act take effect and the possibility of Obamacare subsidies ending at the years close. Charities warn that without intervention from Congress, medical debt will surge and survival rates for conditions like cancer could decline.

Michael Sapienza, CEO of the Colorectal Cancer Alliance, which supports patients with colonoscopies, tests, and cancer treatment, said, Our organization is reaching its capacity for handling requests. Meanwhile, the HealthWell Foundation, one of the largest U.S. medical charities, reports that financial aid is already up 23% compared to all of last year. Their fund launched to assist with rising Obamacare premiums stopped accepting applications after just two days due to overwhelming demand.

The Colorectal Cancer Alliance has seen a 26% year-over-year increase in requests, while CancerCare reports a 10% rise. HealthWell CEO Michael Heimall expects the demand for support to continue next year and expressed concern about whether donors, who also face financial pressures, can sustain or increase contributions. Heimall commented, I dont foresee a decrease in demand anytime soon. As economic pressures rise, donors must choose between contributing to charities or meeting their personal needs.

The strain on health care charities comes amid rising costs and growing pressure on Trump and congressional Republicans to reduce prices. White House spokesperson Kush Desai attributed higher health costs to Democrats, stating that their approach of giving more funds to insurance companies is insufficient. Desai highlighted the administrations efforts to lower drug costs through deals with pharmaceutical companies and addressing system inefficiencies.

So far, five major drugmakers, including Pfizer, AstraZeneca, and Eli Lilly, have reached agreements with the administration to reduce prices in exchange for tariff relief. The government also announced new negotiated prices for 15 high-cost medications, expected to save Medicare beneficiaries $685 million starting in 2027.

Despite widespread insurance coverage through Medicare, Medicaid, or private plans, more Americans report difficulty paying medical bills due to rising deductibles that outpace wage growth. A POLITICO Poll of 2,098 U.S. adults conducted by Public First found nearly half are worried about affording care next year, with one in five finding it very difficult.

Vivian Ho, chair of health economics at Rice Universitys Baker Institute, said, The costs have accumulated over time with no relief. Current policies are not addressing the root causes of high health care expenses. Requests for charity aid mirror the uninsured rate, currently at 8%, and the large number of people facing high out-of-pocket costs. While drugmakers provide some assistance, they cannot support Medicare or Medicaid patients, leaving charities to fill the gap. Assistance programs require verification of income, diagnosis, and insurance status before granting aid.

Charitable health organizations anticipate a surge in requests when enhanced Obamacare subsidies are set to expire. While Trump and lawmakers discuss extending them, agreement has not been reached. Some conservative lawmakers prefer letting the subsidies, increased in 2021, lapse. Enhanced subsidies previously made insurance free for many and extended coverage to higher-income individuals.

According to a KFF analysis, insurers have already raised ACA marketplace premiums by an average of 26% for 2026 in anticipation of subsidy expiration. The Congressional Budget Office predicts 4 million Americans could lose coverage without the subsidies. Trumps July legislation includes nearly $1 trillion in Medicaid cuts over ten years, potentially removing coverage for 10 million people by 2034 due to new work or volunteer requirements, effective 2027.

During the recent government shutdown, Democrats pushed for subsidy extensions. A leaked White House plan proposed a two-year extension with an income cap but no free plans, which Trump did not support. Congressional Republicans are exploring alternatives, including high-deductible plans with redirected subsidies to tax-advantaged accounts, an approach supported by Trump, though no plan currently appears likely to pass.

Charities, including Patient Access Network Foundation, Blood Cancer United, and the Colorectal Cancer Alliance, are urging Congress to extend subsidies. Brian Connell of Blood Cancer United emphasized, Extending current premium tax credits is critical; these Americans lives cannot wait for new policies. Blood Cancer United spent $1.3 million on lobbying in the first nine months of this year alone.

Erin Ercoline, executive director of the ThriveWell Cancer Foundation in San Antonio, warned that unpaid medical bills could be deadly. ThriveWell provided approximately $2.2 million in aid to 1,500 patients this year, the highest since the pandemic, but still turns away about 75% of applicants. Ercoline said, People will not survive treatable conditions due to lack of insurance.

Author's Analysis: Rising Medical Debt and Charity Strain

The surge in demand for medical charity assistance signals a growing gap in U.S. healthcare coverage. Organizations like the Colorectal Cancer Alliance and HealthWell Foundation report double-digit increases in requests, reflecting the financial pressure many Americans face even before potential Medicaid cuts or the expiration of enhanced Obamacare subsidies.

Charities are now operating at or beyond capacity. HealthWell’s aid program for rising premiums halted applications after just two days, and many organizations report turning away the majority of applicants. This strain underscores the systemic issue: rising deductibles and healthcare costs outpacing wage growth are leaving families vulnerable, even among those with insurance.

While the administration highlights negotiated drug price reductions and efficiency measures, experts note that these efforts do not address underlying cost drivers. Without Congressional action to extend subsidies or implement broader reforms, millions could face coverage loss, further increasing reliance on charitable aid and risking outcomes for treatable conditions like cancer.

The numbers are clear: ACA marketplace premiums are already projected to rise by 26% in 2026, and the CBO predicts 4 million could lose coverage if subsidies lapse. Medical charities warn that this will translate directly into more unpaid bills, higher debt, and potentially lower survival rates for serious illnesses.

In summary, the current data paints a stark picture: unless Congress acts, medical debt and charity demand will continue to rise, highlighting a widening gap in the U.S. healthcare safety net and the urgent need for policy interventions to prevent avoidable suffering.

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• Americans are buckling under medical bills. It could get worse.