Health: At what cost?

As young professionals navigate higher healthcare costs than ever before and remain on long waitlists for primary care physicians, some of them are asking: Is insurance worth it, and at what cost?

Despite funds diverted last month by the Massachusetts governor’s office to alleviate the staggering costs of health insurance premiums, made higher by recent federal legislative changes, many Islanders haven’t seen any reprieve. 

Now, individuals and families are faced with some difficult financial choices, especially because the nature of living on an island means other costs, such as food and housing, are already more expensive than elsewhere. 

The bottom line for Vineyard residents, said Dukes County health access representative Sarah Kuh, who works directly with locals to navigate their health plans, is that “people with higher incomes still can’t qualify for tax credits [subsidies], and people with the lowest incomes still can’t [afford] the ConnectorCare plans.” ConnectorCare is the state’s basic insurance plan for residents of the state who make under $62,000 a year. It offers low annual deductibles and co-pays for appointments and medication. 

In an interview with The Times, state Sen. Julian Cyr said locals are only beginning to see the “catastrophic effects of federal legislation” on the state’s health insurance, known as Massachusetts Health Connector, which is used by thousands of Vineyarders. 

“I’m afraid this is only the start,” Cyr added.

The Times spoke with people who work in the restaurant industry, retail, and coffee shops — places where insurance isn’t usually offered as a benefit to employees. Many of the locals who work for the few establishments that stay open year-round said they feel burdened by the cost of health insurance. 

“It’s insane,” said Julia Zephir, the manager of Bunch of Grapes Bookstore, after seeing how much her insurance costs shot up last month. “I was paying a good amount for health insurance before this. But at least it felt manageable at the time. But this bump has been … significant.” 

The crisis of affordability for healthcare many Islanders face now is partly due to the expiration of enhanced federal subsidies. These were Biden-era initiatives through the American Rescue Plan Act that broadened the scope of financial assistance for those enrolled in the Affordable Care Act, commonly known as Obamacare. 

Instead of a cutoff at 400 percent of the federal poverty level, which is $62,000 for a one-person household and $128,600 for a family of four, the enhanced subsidies widened the threshold, making health insurance more accessible to middle-income earners countrywide. 

But those cost buffers expired on Dec. 31, and were not extended by Congress. The recent (and longest in history) government shutdown in October was caused by a bipartisan stalemate over the possibility of that extension. 

At the same time that the subsidies expired, some legislative acts through a Republican spending bill, called the One Big Beautiful Bill Act, went into effect. Since then, over 10,000 people across the state have dropped insurance, including some Vineyard residents who were interviewed. 

The bill, signed into law by President Donald Trump in July, cut over $900 billion from affordable healthcare coverage, and significantly reduced access for millions of Americans, including restrictions on Medicaid. It also ended coverage for anyone without U.S. citizenship. Many changes to the health insurance marketplace through the bill are yet to pan out, and state legislators say the future of health insurance could be far worse. 

In interviews with The Times, Vineyard residents of varying income levels said they have seen increases in their premiums and higher deductibles during open enrollment this year, which was from Nov. 1 to Jan. 23. Deductibles are the out-of-pocket costs for healthcare services before insurance starts to pay, and are a complex system themselves. Back in October, when locals first saw changes to their plans, Kuh told The Times she received calls from hundreds of Islanders who were navigating premium hikes.

Kuh said the federal legislative changes “leave a lot of people out in the cold.”

Waitlisted for care, Islanders still pay exorbitant insurance premiums

A rising number of Islanders are now questioning whether the cost of insurance is worth it, as long waitlists for primary care physicians on the Island remain staggering, though there have been some recent efforts to curtail them, and off-Island trips to specialty doctors are a costly venture. 

“If I can’t use it, then what am I paying for?” asked Alex Wright in an interview with The Times. Wright, 36, is a freelance photographer who works the counter at Mo’s Lunch in Oak Bluffs. 

Wright doesn’t currently have a primary care physician on the Vineyard, and gets his insurance through Massachusetts Health Connector. His monthly premium nearly tripled in January. 

Zephir, the manager of Bunch of Grapes, pointed out that living on Martha’s Vineyard is a privilege, but also creates a unique dilemma. “You can’t get a doctor on the Island, so I don’t really know what I’m paying for,” Zephir, 32, added, echoing Wright’s sentiment.

“I take care of myself. I have a place to live. I have a good job. I can’t imagine having to make these decisions as somebody with dependents, or as an older person, or any of the other factors or variables that go into making these decisions worse,” said Zephir.

Zephir’s premium with Massachusetts Health Connector was about $175 a month in 2025. Now, it’s $600 a month. That’s $7,200 yearly for coverage she only sporadically uses. 

Mac Young, 41, works at Mocha Mott’s, and is an actor. His premiums went up, but he said the increase was mostly manageable. Still, he’s only insured for some doctor’s visits, since most Vineyard dentists don’t accept the state health insurance plan. 

“There was a period of time where I got dental insurance through [Health Connector] and was told flat out by more than one dentist and/or assistant at a dentist’s office, ‘Don’t bother,’” Young said. 

The only dentist on the Island who takes the state’s insurance plans is at Island Health Care’s dental office in Edgartown, which opened a year ago and has cited high waitlists. 

Some locals are choosing to be uninsured completely

While many locals navigate higher monthly bills, some have decided to drop coverage. 

Heather Mangione is one Islander who earns a higher yearly income and has had to grapple with untenable insurance costs. Mangione, 40, is a small business owner who spoke to The Times a few months ago about her rising premiums. She and her wife, Cay Mangione, own Al-Fresco Tails, a dog-walking business. The couple recently decided to forgo health insurance completely. 

“We explored every option available to us — marketplace plans, private plans, and plans through brokers — and none of them were even remotely affordable. The monthly costs simply aren’t something we can sustain as small business owners,” Mangione said. In December, her monthly premium rose from $300 a month to $1,500 monthly (or $18,000 a year) for herself and her partner. 

Mangione reached out to state representatives and advocated for change. She received verbal support from Massachusetts lawmakers, but many of the changes to the insurance marketplace were federal, and some state officials said their hands were tied. 

“There’s a constant sense of uncertainty and vulnerability that comes with being uninsured, especially knowing that one accident or illness could be financially devastating,” Mangione said. “The emotional toll of that shouldn’t be underestimated, and I’m hopeful that our advocacy will amplify the situation with a positive outcome soon.”

Others said they haven’t been covered for a long time. 

“I’ve applied and just got rejected,” Jonathan Perez, 34, the manager at Espresso Love, told The Times. “I worked two jobs and made too much money, and then in the off-season, I just have one job and still don’t [qualify].” 

Perez’s job in the service industry doesn’t offer coverage. When he and his wife were thinking of starting their family, they realized they couldn’t unless they were enrolled in a plan. After being quoted thousands of dollars a month, they decided to wait to have children. “It was just way too expensive,” Perez said. 

Health access representative Kuh said she’s heard many similar stories this year: Islanders who have navigated huge life changes and decisions in the face of rising insurance costs, especially residents who are married without dependents, or work seasonally, and are pushed over the income limit for financial help. 

“The only thing we can do is be empathetic to people’s situations, but we’re the messengers. We’re not the policymakers. And even the Massachusetts policymakers are constrained by federal changes, and so we just do our best to listen to everybody’s case and see if there’s anything we can suggest that might help. And there is not always something that’s going to help,” Kuh said. “So, yeah, it’s sobering.”

State relief programs can’t cover all federal cuts

A state grant of $250 million was filed by Gov. Maura Healey’s administration on Jan. 8 to make up for some of the gap created by the subsidy expiration, but it doesn’t cover everyone. There are nearly 50,000 people statewide who qualify for financial help but won’t see any relief. 

Jason Lefferts, a representative from Massachusetts Health Connector, said the state grant “mitigates the effects of the loss of federal enhanced premium tax credits for about 270,000 people who are in Health Connector coverage.” With 319,000 individuals enrolled in the plan, according to data from Health Connector, there are some who won’t see lower premiums at all. 

The complicated nature of these recent changes has given some locals pause. 

“I wish they would just give health insurance without you having to become an expert in multilevel bureaucracy,” Young said. He’s been enrolled in ConnectorCare since Health Connector was started 20 years ago.

The Massachusetts health insurance marketplace has been described by experts as the best in the country. But even with efforts from state lawmakers to keep it that way, locals are still struggling to manage the changes and understand them. And those tasked with understanding the system said the recent policy changes have made an already complex marketplace much more difficult to navigate. 

“It’s a very complicated system, and it’s always changing, and people’s circumstances change, and it’s just a result of our health insurance system, which is very imperfect,” Kuh said. 

Lefferts said some people who have ConnectorCare may see a financial buffer through the new state grant. But those who make more than $62,000 won’t see a decrease in their estimates. 

And on an Island where the cost of living is much higher, a salary of $62,000 pans out differently for an individual. According to the Dukes County Regional Housing Authority’s 2025 income chart, the area median income for a single person household on Martha’s Vineyard was $105,100 last year. The threshold for “middle-income” is higher in places with soaring expenses across the board.

Sen. Cyr said many Island residents simply make too much to qualify for state relief. While he added he’s proud that Massachusetts lawmakers are stepping up with financial initiatives, a large portion of locals will still be left to their own devices. 

“Often the Islanders and Cape Cod are caught between, given the cost of living here,” Cyr said. “The lack of concern for affordability on healthcare and so much else by the Trump administration and Washington is yet another depressing chapter in this very trying time in our country.”