Carry Smith yawned as she fastened the driver’s side seat belt in her 2002 Toyota Sequoia. On a Sunday in early May, Smith headed to one of her four part-time jobs in Chatham County, part of her seven-day work week.
Two years earlier, Smith suffered life-threatening injuries when a deer crashed into her car. None of her jobs offer health benefits, and so she works every day to afford the insurance that keeps her necessary follow-up medical care accessible.
“What it means to me is my lifeline,” Smith said.
Like hundreds of thousands of Georgia gig workers, small business owners and their employees, Smith’s only option for robust health care coverage is through the Affordable Care Act marketplace, known here as Georgia Access. Last year approximately 24 million Americans enrolled, including 1.3 million Georgians.
But those record levels have fallen sharply in 2026 — and Smith’s struggles illustrate the reasons why. President Donald Trump and Republicans in Congress decided to let enhanced subsidies that started during the Covid pandemic and made plans much cheaper for many more Americans expire on Dec. 31. Premiums soared, and approximately 350,000 Georgians gave up their ACA plans.
That approximately 950,000 Georgians remain insured through Georgia Access is a point of pride for state Republican leaders like Gov. Brian Kemp. Kemp drove the effort to create the state-run exchange and initiate a reinsurance market that made Georgia, which has some of the worst health care metrics in the nation, more attractive to large health insurance companies.That initiative also lowered premiums for some policyholders, though not nearly as much as the enhanced federal subsidies.
“More people are covered today in Georgia than what was promised by the one-size-fits-none, bloated government approach Democrats have promoted in every election cycle,” said Kemp spokesman Carter Chapman.
Smith is one of thousands of Georgians caught in the undertow of these policy decisions. Given her preexisting conditions, Obamacare insurance is the only worthwhile option available to her.
She is grateful for it, though since the start of the year, her premiums have jumped from $45.67 to $330.62 — the cost of a car payment.
A day in the life of Smith illustrates the financial and emotional costs of keeping that coverage.
Finally able to afford insurance
Always healthy, a runner and a doer, Smith went years as an adult without health insurance. She barely spent a dime on medical costs, either. But in 2023, after turning 40, she thought differently. During the pandemic, prices on the ACA marketplace had become affordable for her. She bought coverage that began on January 1, 2024, at a premium price of $136.90 a month. Within a year it fell to $45.67 a month.
Five days after starting that policy, an adult buck ran in front of her car on the night drive home from a work event near Ellabell. Her car careened into a culvert and hit a tree. Flown by helicopter to Memorial Health in Savannah, she spent four hours in surgery to fuse broken vertebrae. The collision broke her neck, ribs and her nose. Her car was totaled.
Her mother, Jan Smith, drove frantically from Tennessee to her daughter’s hospital bed. Smith spent 17 days in the hospital. Then there were complications, and more time in the hospital. Her mother remembered how worried Carry was about the cost of her deductible.
“I said, Honey, that deductible ain’t going to be but a drop in the bucket of what this is going to cost,” her mother recalled.
Just when she thought she was healing at home, a dangerous bacterial infection brought her back to the hospital. The healing took almost six months.
“Probably one of the most difficult times was learning to lay straight,” Smith said. “Because if I didn’t lay flat, then my neck didn’t heal right.”
Smith needed a care team, including an infectious disease doctor who keeps her on antibiotics and a neurologist to monitor her spine.
Her ACA insurance plan was the only sure way for her to access these specialists.
Smith went back to work after her accident as soon as she could, determined to live independently and support herself. But to keep her jobs — she was juggling two at the time — she needed another car to replace the one she totaled. What she could afford was a 20-year-old Toyota, which cost $6500. Community donations helped with a down payment and she financed a $300 per month car loan for the rest.
That cost meant she needed more work.
Searching Craigslist, she found opportunities restocking energy drinks in Savannah-area convenience and grocery stores on weekends, a schedule that leaves her no day off.
Smith’s traditional work week jobs are less mundane. One of her employers is Georgians for a Healthy Future, which advocates for health care assistance. Another is a voter advocacy organization.
Steeped in the world of political policy, Smith was following the debates in Washington last fall when U.S. lawmakers, mostly Democrats, shut down the government to protest the looming end to enhanced ACA subsidies.
Her life got substantially more complicated when the protest failed. When the Obamacare reenrollment period started, her jaw dropped.
The premium for a new plan offering similar amounts of coverage multiplied seven times: from $47 to $330 per month.
Smith had a small stroke of luck. Her car loan payments ended in January, freeing up extra cash to pay for insurance. As long as she kept working 7 days a week.
Her endless grind has emotional and family consequences.
Before the car accident, Smith would travel from Savannah to her parents’ home in Tennessee about once a month. There, she’d visit family, bond with her nieces and nephews. Eat her mom’s home cooked ham, fried potatoes, pinto beans and cornbread; and her grandmother’s potato salad. Her entire family and community are there in Sequatchie County. Her father has a muscular atrophy condition, making it difficult for her mom to come to Savannah.
Over Mother’s Day weekend, the distance was much more painful.
“Of course I miss seeing her,” said her mom, Jan. “And her little niece, she’s absolutely crazy about her. Sometimes somebody’ll pull up and it’s, ‘Carry’s here!’”
Smith is saving for a trip later this year, keeping her fingers crossed that rising costs of life won’t eat up what little she can put away.
Downgrading to stay covered
On paper, many ACA policy holders like Smith still have options for cheaper coverage.
The affordability crisis is so difficult for so many, that significant numbers of Georgians have downgraded their insurance plans to less robust options.
Georgia Access, like all ACA marketplaces, ranks insurance plans into tiers. Silver plans, the mid-tier coverage option, used to dominate the state marketplace. In 2025 70% of policyholders had such plans, while 24% chose a bronze plan. In 2026, only 57% of plans were silver, and 39% were bronze. The jump in the number of bronze plans nationwide is the largest since Obamacare launched in 2014, according to data compiled by the health research organization KFF.
The downgrading of plans — as well as the huge losses of insured Georgians — worry health insurance companies as well as public health advocates.
In a sort of Catch-22, the higher insurance premiums on the ACA can drive prices higher for all Americans, according to Matt McGough, a health policy analyst on the ACA at KFF.
When prices rise, healthy people start to forego insurance, and those who need more care stay insured, making the ACA marketplace a less attractive place for insurance companies to do business.
At the same time, when more people are uninsured, they don’t see a doctor for routine health exams or care, and when they finally seek medical assistance they often can’t pay. Hospital costs that aren’t reimbursed through insurance payments get passed on, normally to other customers in the form of higher prices.
Republican lawmakers cited what they called a broken Obamacare system as a reason to let the enhanced subsidies expire. But in addition, Trump was trying to cut health spending by $1 trillion, not raise it. And extending the subsidies for 10 years would have cost $350 billion.
In reaction, at least one state, New Mexico, absorbed the costs of lost federal subsidies to keep their residents insured. ACA enrollment there soared this year.
In Georgia, such a decision could have an annual cost of $658 million, according to 2024 data from KFF. Gov. Kemp and state Republican leaders in the House and Senate did not discuss such an option during the legislative session that ended in April.
Working more for less
Meanwhile, Smith works seven days a week to keep herself healthy.
One recent Sunday morning, she set off for her first stores in the dappled sunlight . She looked at the positives in her life and what she was fortunate to have. Like the fresh morning air.
“I’ve got a little sunroof, that sometimes I probably shouldn’t open the whole thing, but I open a little of the top part, a little bit,” Smith said.
Before getting to her first job, she stopped at a McDonalds drive-through for a treat, ordering a Raspberry Refresher, what she called “a strong confection.” “I think on a Sunday I deserve it,” she said.
Driving over the causeway towards the job at a convenience store on Wilmington Island, Smith spoke of the tidal river as “majestic.” “I like the fact that this little island, none of these islands, have been too commercialized,” she said.
She pulled up to her first store and took a photo on the company’s app. Each visit is intricately documented from the time of her arrival, to details of the stock she replenishes and the display when she finishes.
As she works, Smith listens to podcasts, BBC World News or a public radio politics podcast. She likes learning. And it takes her mind to a different place, away from her tender spine as she loads heavy pallets of drinks.
Smith describes her own home as organized, and that’s how she leaves the drink displays – “pretty,” in her word. “People tell me it’s because I’m a Virgo” she said. “For me, it’s, I just like doing.”
Smith worked until 7 p.m. that Sunday, restocking five stores and, separately, putting in time as a voting rights advocate.
On the way home, Smith stopped for dinner: Two tacos, sides and a half-sweet iced tea at the Mexican restaurant Cancun. She savored the food and the last hour of sunlight from a window table.
Smith then took a two hour nap, waking up to work on homework until 1 a.m..
In addition to her work, Smith is enrolled in a Ph.D. program in political science at Clark Atlanta University and trying to complete her dissertation.
Pressed for her thoughts on how she makes it all work – the two jobs during the week, the two jobs during the weekend, the advanced degree work stretching in bits and pieces over half her adult life – she concedes.
“It’s hard,” Smith says lightly. “It’s a constant struggle.”
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