Working in healthcare is supposed to insulate you from the worst of America’s medical cost crisis. That assumption, it turns out, is completely wrong — and Glenn Castillo is proof of it.
I met Glenn on a Tuesday afternoon in late February 2026, at a Walgreens on Chicago’s North Side. I was there picking up a prescription when I overheard him at the counter, speaking quietly to the pharmacist about whether the store carried any patient assistance program paperwork for a blood pressure medication his wife takes. He had a lanyard around his neck with a hospital badge. He looked tired in a way that went beyond a long shift.
I introduced myself after he stepped away from the counter, and he agreed to talk. We ended up sitting on a bench outside in the cold for nearly 45 minutes. By the end, I had a clearer picture of what financial collapse looks like when it happens slowly, politely, and to someone who should, by every conventional measure, be okay.
A Nurse Who Can’t Afford to Be Sick
Glenn Castillo is 45 years old. He has worked as a registered nurse at a mid-size hospital in Chicago for nearly two decades. His gross annual income sits at roughly $52,000 — a figure that sounds stable until you map it against the cost of living in Chicago with a family of three, one of whom is a child with significant special needs requiring full-time therapeutic care.
His wife, Marisol, works part-time as a home health aide, bringing in approximately $14,000 a year. Their combined household income lands around $66,000 — close enough to certain federal thresholds to make them ineligible for some programs, yet nowhere near enough to absorb the cost shocks that hit them this year.
“I keep doing the math,” Glenn told me, staring at the sidewalk. “I do it at 2 a.m., I do it on my lunch break at the hospital. And every time I do it, the number comes out the same. There’s not enough.”
The premium increase wasn’t a surprise in the sense that he received a letter about it. His employer-sponsored plan underwent a restructuring in late 2025, and the family tier — which covers Glenn, Marisol, and their son — shifted dramatically. The letter arrived in November. Open enrollment had already closed for the alternatives he might have considered on the federal marketplace.
The Weight of “Going Through the Motions”
When I asked Glenn how he was holding up emotionally, he paused for a long time before answering. “You know that feeling when you’re so far underwater that you stop panicking?” he said. “That’s where I am. I’m not scared anymore. I’m just… moving.”
That numbness, as he described it, had crept in sometime around October 2025, when it became clear that his son’s behavioral therapy provider was raising rates again — from $1,900 a month to $2,200. The therapy isn’t optional. His son, now 12, was diagnosed at age three with a developmental disability that requires consistent, specialized intervention. Pulling back on that care, Glenn and Marisol decided long ago, was not something they were willing to do.
What gets cut instead, Glenn explained, is everything with more flexibility. Retirement contributions. Dental visits. The occasional dinner out. And increasingly, his own prescriptions — including a cholesterol medication he’d been on for three years that, without insurance coverage adjustments, now costs him $112 a month out of pocket.
That’s what brought him to the Walgreens counter. He’d read online that some manufacturers offer patient assistance programs for name-brand drugs. He wasn’t even sure it applied to his situation. He was just trying something.
Navigating a System That Wasn’t Designed for People Like Glenn
After our initial conversation, Glenn agreed to meet again the following week at a coffee shop near his home. Over two hours, he walked me through what the past four months had looked like — a slow-motion scramble through government portals, HR departments, and phone trees.
His first move, in January, was calling his hospital’s HR department to ask whether there was a lower-cost plan he had missed during open enrollment. There was not. His second move was checking the ACA marketplace to see whether a Special Enrollment Period applied to his situation. According to the rules, a significant premium increase triggered by an employer plan change can qualify as a qualifying life event — but his HR department’s characterization of the restructuring complicated that determination, and he ultimately couldn’t get a clear answer from the marketplace call center.
He also contacted the Illinois Department of Healthcare and Family Services about his son’s eligibility for expanded Medicaid coverage under the state’s programs for children with disabilities. His son had been on a waiting list for a particular waiver program since 2023. As of our conversation in March 2026, he remained on that list.
“I’m not angry at the system,” Glenn said, with a flatness that made the sentence feel more resigned than forgiving. “I just don’t have energy to be angry anymore. You file the paperwork, you wait, you call the number, you wait more.”
The One Thing That Actually Changed
The pharmacist Glenn spoke with that Tuesday afternoon pointed him toward the drug manufacturer’s patient assistance portal — a program that covers the full cost of the medication for patients who meet income criteria. Glenn applied online that evening. Within 11 days, he received approval.
His cholesterol medication, which had been costing him $112 a month, now costs him nothing. It’s a savings of $1,344 a year — not transformative, but real. “It was the first time in months something actually worked,” he told me. “I almost didn’t believe it when the letter came.”
The bigger problems remain largely unsolved. His retirement savings, which he estimated at roughly $18,500 in a 401(k) he stopped contributing to in October 2025, continue to stagnate. His son’s waiver application sits in a queue. The insurance premium has not changed. But Glenn had also, by the time we spoke in March, connected with a benefits navigator through a local nonprofit who was helping him build a more complete picture of what he might qualify for — including the IRS Premium Tax Credit for marketplace coverage, should he ever become eligible for a Special Enrollment Period.
What Glenn’s Story Reflects About Low-Income Healthcare Workers in 2026
Glenn’s situation is not anomalous. Registered nurses, home health aides, medical assistants, and other healthcare support workers frequently fall into income brackets that place them too high for robust public assistance and too low to comfortably absorb employer plan cost-shifting. A 2025 analysis by the Kaiser Family Foundation found that average employer-sponsored family premiums have climbed by roughly 24% over the past five years, with employee contributions bearing a growing share of that increase.
For workers like Glenn — whose income is consumed by a child’s disability-related care — the margin between stable and precarious can be measured in a single plan restructuring letter. The retirement savings concern he mentioned, almost as an aside during our second conversation, struck me as particularly telling. At 45, with $18,500 in his 401(k) and contributions paused indefinitely, the math of his future is one he doesn’t let himself look at too closely.
When I left him at the coffee shop, Glenn was tucking a folded piece of paper into his jacket pocket — a list of benefits resources his navigator had given him. He was going to look through them that night, he said, after his son was in bed. He didn’t sound hopeful, exactly. He sounded like someone who has learned to keep moving regardless of what the math says.
That, more than anything, is what stayed with me. Not the numbers — though they tell a damning story on their own — but the particular kind of endurance it takes to keep filing paperwork, keep calling numbers, keep showing up to a job that heals other people, when no one seems to be handing you a prescription for what you’re dealing with.
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