The morning I drove to meet Tanya Kirby, the sky over Baltimore was the flat gray of a February that hadn’t decided to end. She’d agreed to meet me at a coffee shop near her daycare center in the Waverly neighborhood — a place she’d chosen, she said later, because she didn’t want to talk about money inside the building where she employs twelve people. The symbolism of that wasn’t lost on either of us.
A social worker at the Baltimore County Department of Social Services had pointed me toward Tanya after I’d spent weeks trying to find someone who could put a human face on the COBRA coverage crisis hitting small business owners in their early sixties. “She’ll talk to you,” the social worker told me. “She’s been trying to get someone to listen for two years.”
The Insurance That Costs More Than the House
Tanya Kirby is 61 years old, married, and owns a licensed daycare center she has run for fourteen years. By most measures, she is comfortably upper-middle class — her business generates roughly $310,000 in annual revenue, and she and her husband Marcus take home a combined income of about $115,000 after payroll and overhead. That should be enough. For a long time, it was.
Then, in the spring of 2024, the small group health plan she had carried through her business was discontinued by her insurer after the carrier pulled out of Maryland’s small group market. Her broker found her a replacement plan — but the new premium, covering Tanya, Marcus, and their 19-year-old son Darius, who has autism and requires full-time structured support, came in at $2,387 a month through COBRA continuation coverage.
Her mortgage on a three-bedroom rowhouse in Baltimore’s Govans neighborhood runs $2,140 a month — a loan she refinanced at what felt like the right moment in 2021, only to find herself over-leveraged when her business cash flow tightened. The health insurance premium is now $247 more per month than the house payment. When I asked her how she reconciled that, she laughed the kind of laugh that isn’t funny.
The Numbers Behind the Squeeze
To understand how Tanya ended up here, it helps to see the full picture of what she’s carrying. Between the mortgage, the COBRA premium, and a $430-a-month payment on a business line of credit she took out during the pandemic, her fixed monthly obligations top $4,957 before utilities, food, or any of Darius’s specialized services — many of which aren’t fully covered even under their current plan.
The home itself has become a secondary crisis. The rowhouse, which Tanya and Marcus purchased in 2009 for $198,000, needs a new roof — contractors have quoted her between $14,500 and $19,200 — and the HVAC system is original to the 1960s structure. She got one estimate to replace it: $8,700. She hasn’t moved on either repair. “The house is basically telling me things every month,” she told me, “and I’m telling it to wait.”
According to the U.S. Department of Labor’s COBRA guidelines, continuation coverage can last up to 36 months in certain qualifying circumstances. For Tanya’s family, the clock runs out in the spring of 2027 — still more than two years before she turns 65 and becomes eligible for Medicare.
The Side Hustles and the Scramble
Tanya is not someone who sits still. Before I’d finished my coffee, she had mentioned three separate income streams she’d launched in the past eighteen months to offset the insurance burden: a weekend tutoring service she runs through the daycare space, a contract she negotiated with a local preschool to train their staff on developmental milestone tracking, and an Etsy shop selling educational activity kits she designs herself. Combined, these bring in approximately $1,400 to $1,900 a month, she estimated — though she was quick to add that “estimated” was doing a lot of work in that sentence.
“I’m always running,” she said. “Marcus thinks I never sleep, and he’s not wrong. But what’s the option — drop the insurance and hope Darius doesn’t have a medical event? That’s not a real option.” Darius receives behavioral therapy twice a week and sees a specialist quarterly. Tanya figures his care costs, even with insurance covering a portion, run about $800 a month in out-of-pocket expenses.
She looked into Maryland’s ACA marketplace plans as a possible alternative to COBRA. At her household income level, the premium tax credits available through HealthCare.gov would have been minimal — her combined household income puts her comfortably above the thresholds where meaningful subsidies kick in. The comparable silver-tier plans she found would still cost $1,900 to $2,100 a month and came with narrower networks that her son’s specialists were not part of. She stayed on COBRA.
The Gap That Doesn’t Show Up on Paper
What struck me most about Tanya’s situation wasn’t the dollar amounts — though they’re staggering — it was how invisible her stress is from the outside. She runs a licensed, inspected, well-regarded childcare business. She owns a home. She and Marcus both work. On paper, she is doing fine. In practice, she is one bad quarter or one major repair away from a serious financial rupture.
According to KFF Health Cost data, the average annual family premium for employer-sponsored coverage in 2024 was approximately $25,572 — meaning Tanya’s COBRA cost of $28,644 annually is running about 12 percent higher than the national average for employer-sponsored family plans, partly because she has no employer to absorb any share of the premium.
The four-year countdown to Medicare eligibility at 65 has taken on a psychological weight in their household. Tanya mentioned it twice in our two-hour conversation without me prompting it. “Marcus and I literally have it on the calendar,” she told me. “Like a vacation we’re saving up for. Except the vacation is just: normal.”
What Comes Next — and What Doesn’t
By the time we wrapped up, Tanya had ordered a second coffee she didn’t drink. She was already thinking about her afternoon — she had a staff meeting at 2 p.m. and a call with an accountant about first-quarter business taxes. The restlessness her friends have teased her about for years is also, she acknowledged, what has kept her solvent through a genuinely punishing stretch.
She’s exploring whether she can restructure the daycare as a formal employer-sponsored plan again now that enrollment has grown to 38 children — the break-even point at which a small group plan might become viable again. She’s also been looking into whether Darius would qualify for Maryland Medicaid’s developmental disabilities waiver program, which could absorb a portion of his specialized care costs and reduce the household’s insurance burden. No decisions have been made. The calls are still being made.
When I left the coffee shop and walked back to my car, I sat for a minute before starting the engine. Tanya had already disappeared down the block toward her building, moving fast, the way people move when there’s always somewhere to be. Four years is a long time to hold something together. But she has been holding it together. And for now, that counts for something.
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