Congress asks health plan CEOs about premium increases and affordability
Lawmakers pressure health care CEOs over rising premiums and affordability concerns under the Affordable Care Act
Stacey Cox and her husband are self-employed, so they don’t have health insurance through their employer.
A Utah couple turned to enhanced Affordable Care Act subsidies to lower their premiums to $500 a month in 2025. Monthly premiums soared to more than $2,100 after Congress failed to extend the subsidy last year.
It was too much.
“We’re caught in the middle,” Cox said. “We don’t qualify for additional assistance because we earn too much. But we don’t earn enough to pay the $2,100 monthly premium.”
More Americans are struggling to pay for health insurance, medical bills, and prescription drugs. According to the West Health Gallup Affordability Index released June 18, less than half of adults say they can afford to pay for medical bills, appointments, and prescriptions.
An additional 41% of Americans are “cost insecure” because they don’t have access to affordable care or are unable to pay for care or medications, according to West Health Gallup, based on a survey of 5,660 adults ages 18 and older.
At a time when health insurance and medical care prices are outpacing inflation and wage growth, other studies have shown that people are struggling to pay for living expenses, regular doctor visits, or needed prescriptions.
An American Heart Association Harris Poll released this month found that half of American workers say medical costs make it difficult to cover living expenses such as child care, food and rent. And a survey released June 10 by the Urban Institute found that 46% of working-age adults in the U.S. struggle to cover their family’s medical costs.
Erin Mace, director of research at West Health Gallup Medical Center, said the group’s research highlights how Americans are struggling to cover rising health care costs.
“Less than half of Americans say they can afford to pay for their medications, hospital visits, and continued access to quality care,” Mace said, noting that this is the first time West Health Gallup has reported that fewer than 50% of adults feel confident about their health care costs.
Rising insurance premiums and prescription costs
The Centers for Medicare and Medicaid Services reported on January 28 that approximately 23 million Americans will have ACA coverage in 2026, down from 24.2 million in January 2025. But the number of people who dropped their ACA coverage won’t be known until CMS reports more solid enrollment numbers later this year.
The expiration of enhanced ACA subsidies will mean higher premiums for millions of consumers, while other health costs such as prescription drugs, medical tests and hospital bills will also weigh on consumers, experts say.
Employers, which provide health insurance to most working-age Americans, are grappling with rising costs. Companies are expected to spend an average of $18,500 per employee on health insurance in 2026, up 6.7% from a year ago, according to consultant Mercer.
“This is not a story about one villain,” said Howard Forman, a physician and professor at Yale School of Management. “This is about a system that ultimately ends up costing us more and more money over time. We just don’t have the kind of math in this country that we need.”
“Have you reached your breaking point yet?”
When Cox, 49, and her husband, John Crowley, 55, learned that their ACA insurance was more than four times as expensive, they looked for cheaper options and settled on a $565-a-month short-term insurance plan.
Short-term plans typically have lower monthly premiums, but often lack protections for consumers who purchase their own health insurance.
Short-term plans do not cover pre-existing medical conditions or preventive care. And the plan Cox and Crowley chose came with a $10,000 deductible, an amount that must be paid before coverage begins.
Cox and Crowley are healthy adults who are neglecting care and recommended medical tests because they cannot afford the fees charged by their medical providers. They maintain short-term plans as protection against medical emergencies.
Mr Crowley recently suffered a medical scare after developing pain and numbness in his legs. Cox said he delayed going to the doctor, but the pain got worse. He needed an MRI scan, which an imaging center affiliated with the local health system said would cost $2,200 with insurance or $1,600 if paid in cash without insurance.
Either way, he has to pay the full amount because his insurance plan includes a $10,000 deductible. If I chose the lower $1,600 cash price, I was told that that amount would not apply to my insurance plan’s deductible.
Cox said she was “upset” because the health system’s imaging offered her a $600 discount for not submitting documentation to her insurance plan.
“It felt like blackmail,” Cox said. “Are you going to pay an extra $600 just to put that toward your deductible?”
They eventually found another imaging center in St. George, Utah, that could complete the MRI for $399. The low price made it worth the couple’s 90-minute drive to the center and back.
However, the additional costs of minimal insurance plans are straining household budgets. They cut back on vacations, eating out, and streaming services.
We have both built successful businesses that we love. She is a photographer and he is an audio engineer. However, they consider taking a corporate job just to get health insurance provided by their employer.
“We have a very good life. We have enough income to pay the mortgage, car and auto insurance,” Cox said. “Every month, we come back to the table and say, ‘Have you reached your breaking point?’ It all comes down to health care.”
Email Ken Alltucker at alltuck@usatoday.com
