Jim Hansen and his wife considered themselves fortunate when they retired five years ago.
The Denver couple, both electrical engineers, were healthy. They'd socked away an ample nest egg. And they found health insurance that, if not cheap, seemed reasonable for two people in their late 50s.
Then, the math started to change. Since 2015, the couple's annual premiums have more than tripled and may hit nearly $18,000 next year.
"It just doesn't make sense," said Hansen, who has had to recalculate his retirement finances.
The Affordable Care Act made life-saving protections available to millions, many for the first time. But the transformation of the nation's insurance markets has been a bumpy ride, particularly for one group — people like Hansen who get health insurance on their own, rather than through a job, but whose income is too high to qualify for government aid.
Now, these same consumers, whom Republicans have held up as victims of the current law, stand to see insurance bills soar even higher unless Congress acts quickly to stabilize insurance markets that have been weakened by the Trump administration.
Hansen's insurer, Cigna, plans to increase premiums for individual insurance plans in Colorado by an average of 31% for 2018 -- one of many double-digit increases slated to hit consumers around the country next year.
"Many of these people are just normal, middle-class folks," said former Kansas insurance commissioner Sandy Praeger. "And they're just not going to be able to afford coverage."
Praeger, a Republican, is among a bipartisan chorus of state regulators, governors and health insurance officials urging Congress to take a set of relatively simple steps to stabilize markets and help consumers like Hansen.
A group of Republican and Democratic senators is now racing to put together legislation.
The work was derailed in mid-September by the recent GOP push to repeal the law. Negotiations in the Senate health committee have now resumed, but it's unclear whether a bill can make it through a bitterly divided Congress in time for insurers to scale back big premium hikes planned for 2018.
"They need to act yesterday if not sooner," said Anthony Wright, head of Health Access California, a leading consumer advocate in the state.
Before the Affordable Care Act, the so-called individual market survived largely because insurers were able to turn away sick consumers, allowing health plans to keep premiums in check for the healthy people they chose to serve.
That meant millions of Americans were locked out of coverage if they had pre-existing medical conditions such as cancer or diabetes. Even minor ailments such as acne were used to deny coverage.
At the same time, health plans routinely imposed annual and lifetime caps on how much medical care they would cover and excluded coverage of prescription drugs, mental health, substance abuse treatment and other services.
"This was a critical weak link in our system," said Karen Pollitz, a market expert at the nonprofit Kaiser Family Foundation.
But for healthy Americans, plans could be relatively affordable, especially for consumers willing to buy plans with high deductibles or limited benefits.
For the first few years after Hansen and his wife retired in 2012, they enrolled in plans that cost less than $5,000 a year.
"That worked for us," explained Hansen, who lives in a modest brick house in one of Denver's older neighborhoods.
He budgeted about $100,000 for health insurance in the couple's retirement plan, calculating that would get him and his wife to age 65, when they would qualify for Medicare, the government health plan for the elderly.
Then the market began to change.
The advent of new consumer protections in 2014, including guaranteed coverage for the sick, brought consumers with untreated illnesses, many of whom couldn't previously get insurance, into the market. That pushed up insurance premiums for healthier people.
Hansen and his wife kept their premiums in check for a couple years by switching to plans with higher deductibles.
Then, in 2016, their annual premium for a plan with a $7,000 deductible jumped from $4,350 to $13,200.
It got worse in 2017, forcing the couple to switch plans and switch doctors.
Although the specifics of what will happen to Hansen's plan haven't been finalized, according to a company spokesman, the 31% increase the company expects on average would put the couple's 2018 premium at $17,685.
"Needless to say, we're pretty angry," Hansen said.
"Something just seems way out of whack here," he said. "It seems like everything about the way we are being treated is unfair."
The vast majority of Americans receive substantial government assistance to buy health insurance.
People who get a health plan through an employer get a tax break because health benefits aren't taxable. That tax benefit is most valuable to upper-income Americans.
Americans older than 65, who qualify for Medicare, also get help. Although they paid into the program through payroll taxes, those payments cover only part of the program's cost, and the government significantly subsidizes the cost of care.
The poorest Americans typically qualify for nearly free care through Medicaid.
And even many of the people who buy insurance on their own now get assistance through subsidies provided by the 2010 law. Those subsidies – available to consumers with incomes between 100% and 400% of the federal poverty level, or between $12,060 and $48,240 – have protected many from the recent rate hike and in many cases mean the difference between a double-digit rate hike and a rate decrease after subsidies.
But more than 10 million Americans - some uninsured — don't fit into any of those categories and, as a result, don't get any assistance.
Their difficulties have been a major focus of Republican calls to repeal the current law and loosen insurance regulations to make coverage more affordable.
The changes the GOP has proposed might help some consumers, according to independent analyses by the Congressional Budget Office and others. But looser regulations would also likely mean higher costs for people with pre-existing medical conditions and for many older consumers nearing retirement, the budget office and others have warned.
Other GOP plans also have included proposals to give Americans who buy health coverage on their own the same tax break enjoyed by people who get coverage through an employer.
In the short term, most state regulators, insurers, consumer advocates and others say Congress and the Trump administration could slow rate hikes for people like Hansen with a few basic steps.
These include providing funding to protect insurers from high-cost patients and to offset the cost of consumers who can't afford their deductibles and co-pays.
It also includes enforcing the law's requirement that everyone have insurance and aggressively working to get more people to sign up for health plans. The Trump administration is instead making plans to dramatically scale back advertising and outreach efforts for 2018.
"The best thing we can do for people is to enroll a whole lot of healthy folks," said Christopher Koller, the former insurance commissioner of Rhode Island.
For his part, Hansen said he and his wife will be able to keep paying their premiums. "For us, it's survivable," he said. "We're lucky."
But he remains perplexed by the inability of leaders in Washington to address the problem. "It seems like reasonable people ought to be able to fix this," he said.