Marek Studzinski representational image via Unsplash
Healthcare costs will skyrocket in 2026, as millions of consumers face a 100% increase in their monthly premiums.
Congress Can Fix Skyrocketing Health Care Costs: But Will It?
By Sunita Sohrabji
CA
The Senate Dec 11 will vote to continue the Affordable Care Act’s Enhanced Premium Tax Credits, potentially bringing relief to millions of ACA consumers who have seen their monthly premiums double for 2026.
Enhanced premium tax credits are currently set to expire at the end of December. Senate Democrats have proposed a “clean” resolution which would leave EPTCs in place for the next 3 years. The House is set to vote on the issue on Dec 18. EPTCs were at the heart of the government shutdown in November, as Republicans resisted extending the credits.
More than 24 million people buy their health insurance on the ACA marketplace; 92% qualify for EPTCs.
Dropping Off Healthcare
Jacki Noh told American Community Media that she had received her Open Enrollment statement in November: monthly premiums for Jacki and her husband will rise from $1,300 per month to $3,000.
“We are seriously thinking of dropping our insurance altogether, although we probably won’t. We’re doing our best to get all necessary tests and doctor visits done before Dec 31,” said Noh. She noted that she had recently traveled to Seoul, Korea and caught a bad cold: the total cost for two tests, two doctor visits, and all medications was just $67.
Tomas Bednar, senior vice president and counsel at Healthsperien, LLC, predicted that millions of Americans would drop out of health insurance coverage if the tax credits are not extended. “We are at one of the lowest points of the uninsured population in the history of the United States. But that has the possibility of fundamentally rebounding,” he said, at a Nov 21 American Community Media news briefing.
Price Increases for All Consumers
Bednar predicted that health care costs would rise for all consumers. “In health policy circles, we often treat healthcare costs as the analogy to the balloon. And if you eliminate large portions of the population from that balloon and leave only the more costly, the sickest — who are more likely to have access to coverage through Medicaid — you by definition increase the overarching pressure on the payers, whether that’s government-sponsored payers, or whether that’s commercial payers.”
HR 1 — also known as the One Big Beautiful Act passed by Congress late summer — strips over $1 trillion from the Medicaid budget over the next 10 years. Bednar noted the burden would be shifted to states to find funding to backfill the federal cuts, or to eliminate portions of their Medicaid program and limit access.
In California, Medicaid is known as MediCal.
2026 will also be the first year that Medicare will negotiate drug pricing. Bednar noted that negotiations began under the Biden Administration’s Inflation Reduction Act, which was successful in negotiating prices for 15 medications, including those addressing diabetes, heart and kidney disease, and certain cancers.
Drug Pricing
“Drug pricing remains one of the hard to characterize topics of conversation in health policy,” said Bednar, noting there have been meaningful reforms in the Biden and Trump Administrations.
The Trump Administration has not repealed the negotiations. “Implementation has carried on largely unaffected by this administration,” said Bednar. “Moreover, President Donald Trump has made not just overtures, but some very concrete policy steps towards changes in the pricing for the payment of drugs, particularly in the government-sponsored healthcare side of things, Medicare and Medicaid.”
“The merits of those changes can be hotly debated, but there is a stark contrast between what the first Trump administration did, which was mostly talk about such changes, and what they’ve sought to do here: seeking to implement many such changes. And I think 2026 will be where we start to see some of the net effects for consumers,” he said.
Affordable Healthcare
At the Nov 21 news briefing, Sophia Tripoli, senior director of health policy at Families USA, laid out her organization’s vision for more equitable and affordable healthcare.
“We are at a turning point on one of the biggest kitchen table issues in American life, the cost of health care. Most people feel this in a very personal way, when their premiums go up, when they get a surprise bill, or when they’re forced to choose between medical care and groceries,” said Tripoli.
“Health care prices are being pushed higher by two structural forces that have little to do with the health of the American people. It’s corporate consolidation and payment incentives that reward volume over value,” she said, noting the consolidation of forces that are the backbone of health care in America.
Consumers Not Getting Better Care
“When companies get bigger, they get more power to raise prices. Hospitals merge or acquire physician practices and then demand higher rates from insurers. Drug companies maintain patent thickets to block cheaper generics from coming to the market. Insurers consolidate and narrow provider networks. And consumers don’t get better care. Instead, we get higher premiums, higher deductibles, and confusing bills that bear no relationship to the cost of providing care,” said Tripoli.
“The system rewards doing more, not doing better. It rewards expansion, not efficiency, and it certainly doesn’t reward prevention or the financial security of families.”
Congress has the ability to reform health care accessibility and affordability, said Tripoli. She offered several actions Congress could take, including:
- stopping corporate health systems from charging Medicare more for the same procedure simply because it was done in hospital rather than a doctor’s office
- requiring all hospitals and health plans to actually disclose the price of healthcare services in dollars and cents so that patients know how much a procedure costs before they get care
- closing legal loopholes that allow drug companies to raise prices through patent abuses
- restricting predatory billing practices that inflate healthcare costs for families
- prohibiting Medicare Advantage plans from exaggerating patients’ health risks to get higher payments for Medicare
- modernizing pay for care so that providers are rewarded for keeping people healthy, not just for the number of services or procedures that they perform
American Community Media
