I feel very fortunate that I’ve reached the age where I qualify for Medicare. Although Medicare can be improved upon, with a monthly amount taken out of our Social Security payments and an additional monthly fee for each of our Medigap supplemental plan G policies, our total annual costs out-of-pocket is $8653.92 assuming we each pay our $283 annual deductibles. Add to this our Medicare D drug plan costs which are minimal.
The January 22, 2026 edition of the New York Times published an Opinion Guest Essay by Tracie McMillan. She offered several examples of the much higher annual premiums that people are expected to pay due to the expiration of the enhanced health insurance tax subsidies at the end of 2025. Mary Beth Bognar, age 36, from Westerville, Ohio, as a nonprofit consultant, with a household income of $111,000, saw her monthly premiums for 3 people increase from $775.09 in 2025 to $1603.09 in 2026 (more than twice as much) and with a maximum out-of-pocket cost for the year of $37,537.08 (more if they go out of network for their care).
Judith Garber, a Senior Policy Analyst at the Lown Institute, wrote in a blog post on 1/27/26, “Everyone agrees that healthcare is too expensive, what industry players can’t agree on is why.”
She mentions three drivers of healthcare expense. The first is health insurance premiums. Employer-based plans have increased again by 6% in 2026, two times the recent national annual inflation rate. However, those who relied on the marketplaces for Affordable Care Act (ACA) plans have seen their premiums increase by on average, 21%.
It’s not just the premiums. The average annual deductible for employer-sponsored plans in 2025 was $1,886. In addition, 46% of employer-sponsored plans have an out-of-pocket maximum exceeding $5,000 for individual plans, higher for family plans. For ACA plans, the average deductible for a silver plan is $2,912. Bronze plans have lower premiums, but their average deductible has climbed to $7,476. Remember that the majority of families in our country have $500 or less in emergency savings. If they experience a “bad health” year, they will become medically indebted and some medically bankrupt.
The second driver of healthcare expense is escalating prices. Health insurers claim higher hospital and medication charges are the cause of their increased premiums to customers.
The largest drain of healthcare dollars is hospital care. It consumes 31% of total national health expenditures. Hospital prices have climbed at a faster pace than doctor charges or insurance profits. Hospital charges are extremely baffling. In a recent report, several academic medical centers were surveyed. The median charge for a coronary artery stent ranged from $657 to $25,521. Even within the same hospital, depending on which insurance company was charged, the price ranged from $11,325 to $23,392. Why is there so much variation in price?
The cost of medications certainly contributes to healthcare unaffordability. GLP-1 medications were used first in diabetes but now have found a much larger patient population in the treatment of obesity. These medications have been priced at about 10 times the cost of their production. In general, pharmaceutical companies have been the most profitable healthcare sector. Over the last 20 years, they have earned over $1 trillion in profits. Pharmacy benefit managers (PBMs) and vertical integration of healthcare systems have also contributed to acceleration of healthcare costs in our country over the last several decades.
Third, there are larger forces that contribute to our present healthcare unaffordability crisis. Michael Chernew has indicated there was a greater use of health services in general and high- intensity services which he attributed to delayed care during the COVID-19 pandemic and challenges such as long COVID which resulted from this pandemic.
How does this affect us? A recent Kaiser Family Foundation survey found that 36% of adults have skipped or postponed care because of costs. One in five did not pick up a prescription because they could not afford their deductible. The higher deductibles and co-pays persuade patients to postpone care which ultimately leads to more severe illness and poorer outcomes when those individuals do seek care. The Congressional Budget Office projected that 2.2 million Americans would lose their health insurance in 2026 if the enhanced tax subsidies expired because they no longer can afford health insurance.
Dean Baker, a well-respected economist, explains that even if you can afford your higher health insurance premiums, in a year where you need significant care, the deductibles and co-pays will be overwhelming for many Americans. Judith Garber points out, “the failure of wages to keep up with the escalating cost of living makes everything unaffordable.”
Wendell Potter, an ex-health insurance executive, believes that health care costs should become a front-burner issue in the 2026 midterm election. He states “The first step toward a solution is a government that will acknowledge that, because of insurers’ greed and incompetence, almost no one in America can afford coverage unless an employer or government heavily subsidizes it, and that the giant for-profit insurance conglomerates that control our health care system are the reason why that is our reality.”
