As health care costs skyrocket and federal lawmakers pull back help on insurance premiums, more middle-income families are facing tough choices on health care.

Many Americans are expected to lose ACA or Medicaid coverage in coming months and years as a result of the One Big Beautiful Bill Act and the expiration of enhanced pandemic-era subsidies that helped people afford Obamacare plans. Doctors and researchers say there are still ways to find affordable care.

Millions of people gained health coverage under the Affordable Care Act, reducing pressure on counties in states that fund care for the uninsured. With federal policies expected to reverse that trend, county officials wonder how they will fill the gap — and who will pay for it.