For many families, an income of $100,000 pretty much means they’re living the American dream. And for many families, that dream came crashing down when they saw what their health care premiums are going to be for 2018.

For Sara Stovall, premiums for her family of four will go from $940 a month to nearly $3,000 a month—$36,000 for the year.

Eden Henderson’s premiums for her family of three jumped 225 percent to $2,600 a month.

And John Harris, former Carlyle Group CFO, says the $1,629 a month silver plan he’s currently paying for his family of four with Anthem will cost $5,395 a month—nearly $65,000 for the year—for the same plan next year with Optima. For laughs he calculated a gold plan. That totals nearly $97,000 a year.

It’s difficult to pin down why Charlottesville and Albemarle, Fluvanna and Greene counties have seen the largest jumps in the country—234 percent for a 40-year-old ineligible for subsidies, compared to a 17 percent to 35 percent increase nationally, according to the Kaiser Family Foundation.

JABA insurance counselor Heather Rowland puts the blame squarely on the Trump administration for destabilizing the market by stopping federal cost-sharing reduction payments, which subsidize lower deductibles, copays and out-of-pocket maximums, and for threatening to end the individual mandate that requires everyone to have insurance, which caused insurers to fear they’d be stuck with older and sicker buyers.

As a result, companies like Anthem and Aetna, which used to be in Albemarle, pulled out, while the sole remaining insurer, Optima, sharply raised its premiums to cover the riskier pool.

Rowland also believes the constant refrain of “repeal and replace” further destabilized the market. Fifth District Congressman Tom Garrett ran on a platform last year of repealing the Affordable Care Act because insurance premiums were too expensive, and he says President Barrack Obama acknowledged “real problems” with the ACA.

The second American Health Care Act would have reduced premiums—if it had passed in the Senate, says Garrett. Premiums of $36,000 a year are “ridiculous,” he says. “We need to keep doing our job.”

House Minority Leader David Toscano says he’s heard from many constituents faced with unaffordable health care. “Some people are under the misguided viewpoint that the Affordable Care Act is responsible,” he says. “In fact, it’s the Trump administration undermining the market.”

Optima decided to stay so that Charlottesville residents would not be left without an option, and “to provide plans knowing they might be out of reach for some residents but give an option to an estimated 70 percent who would qualify for subsidies,” says Optima spokesperson Kelsea Smith in an email. “We chose to cover as many people as we could.”

As for why Charlottesville and Albemarle premiums skyrocketed to the highest in the country, says Smith, “First and foremost, we understand residents’ frustration. We knew these rates would be difficult for some. We wish the circumstances were different, but to leave everyone without an option was not acceptable and goes against our not-for-profit mission.”

Among the factors she lists: The health insurance exchange has not worked as originally envisioned. Younger, healthier patients have not gotten insurance to offset the costs of older, sicker citizens. And without other insurance companies here, “all the risk of covering this more expensive patient base was left on the shoulders of Optima,” she says.

Sentara owns both Optima and the former Martha Jefferson Hospital. Despite having two hospitals, Smith says an academic medical center like UVA is more expensive than other hospitals.

When Stovall logged onto healthcare.gov November 1 and saw the lowest rate she could get was nearly $3K a month, “It was so absurd my husband and I laughed,” she says. “This is a $36,000 a year plan with a $12,000 deductible. How can anyone see that as remotely reasonable?”

She and her husband talked about moving, or she may look for a job that pays less. “In past years we’ve always tried to make as much money as we can,” she says. The one option she’s not considering with two young children is going without insurance.

“People say if you make more, you should pay more,” she says. “I agree. But you assume it’s reasonable. It doesn’t mean we can pay one-third of our income. That’s double our mortgage.”

The good news is for people who are single and make under $48,000 or a family of four earning less than $98,400. Those earners still qualify for subsidies under the Affordable Care Act, at least for 2018, according to Rowland.

Stovall found that if her family made under $98,000, she could get an insurance plan for $10 a month.

But she warns of a caveat with the non-sliding scale. If you earn $1 over those subsidy-eligible limits of $98K, you owe the full $36,000 cost.

“A lot of people could get stuck by not knowing that,” she says. “That could be devastating.”

What you should know

• Sign-up in the health marketplace lasts 45 days—half of previous years—and ends December 15.
• Advertising has been eliminated, and healthcare.gov is seeing 12-hour maintenance shutdowns every Sunday during the open enrollment period, says insurance counselor Heather Rowland.
• In Charlottesville, where the median household income was around $64,000 and the median per capita income is $34,000, according to a U.S. Census 2016 survey, many people will be eligible for affordable health care insurance, at least for 2018.
• The self-employed have been hardest hit. Some are looking at hiring employees to qualify for group insurance. Other options include short-term insurance, which does not cover pre-existing conditions, and the Christian cost-sharing ministry Medi-Share, which is not insurance but is exempt under the ACA’s individual mandate.