When it comes to health insurance in Texas, lower-income families arguably stand the best chance of getting the policies that meet their needs. The wealthy are often able to afford plans out of pocket or through corporate jobs. For the middle class, however, the rising cost of health insurance puts them in an unfavorable gray area. They may make too much money to qualify for premium tax credits but too little to afford decent health benefits on their own.

According to NPR, the Trump administration’s decision to cut subsidies to insurance companies plays a potential role in driving up the cost. Lower-income families reportedly still receive those discounted prices from insurance companies. They also take advantage of premium tax credits provided by the Affordable Care Act.

The people taking the biggest hit include individuals making more than $48,000 or families of four who cross the $98,400 threshold. The people who need health care most may try to purchase from the ACA Marketplace, while everyone else may either do without health care or purchase it on their own.

A 2019 follow-up on the state of health insurance costs for middle-class Americans confirms the original projections by NPR. Some Americans pay more than 10% of their income for health insurance. There has been a rise in deductibles and overall premiums in the past few years. This may tie back to insurance companies trying to make back the money lost from providing discounts to lower-income families without government subsidies.

Between 2008 and 2018, the median household income in America rose by an average of 1.9% per year. In contrast, the deductibles and premiums paid by the middle class rose by 6% each year during the same time frame. Soon, middle-class Americans may get priced out of the market, putting them at further risk for high medical debts.