Health Insurance Should Support Families, Not Burden Them
Health insurance is designed to offer families support, yet when large insurance companies and their lobbyists in Washington don’t achieve the outcomes they want, they often resort to a familiar tactic: increasing premiums.
This situation creates pressure, and it’s the patients who feel it the most.
We’ve seen similar patterns before. Back in October 2017, the government discontinued cost relief payments, prompting airlines to respond the following year by “silver loading,” which led to a significant rise in silver plan premiums—as analysts had predicted. According to the Kaiser Family Foundation, the end of these payments resulted in an approximate 20% hike in silver premiums, increasing federal costs in 2018.
Fast forward to what’s on the table now—market filings for 2026 indicate the steepest proposed increases since that earlier shock, with a median rise of 18%. Insurers cite various factors: rising hospital costs, increased utilization, expensive GLP-1 medications, and uncertainties surrounding the Affordable Care Act’s enhanced tax credits potentially expiring. Both Kaiser and Health System Tracker have highlighted subsidy issues in their filings, which national news outlets are linking to the current budget impasse in Washington.
Interest rates aren’t just arbitrary; they involve mathematical principles. A healthy market relies on analyzing recent claims and costs, then projecting future expenses. Regulations like guardrails mandate that plans must spend 80 to 85 percent of premiums on medical care—or issue rebates. But these mechanisms work only when there’s transparency and enforcement.
Lack of transparency is a real concern. Many public actuarial notes are often obscured. Key tables can be redacted, labeled as “trade secrets.” While regulators may have a general understanding, the public—including families and reporters—usually doesn’t. When an insurer states “costs have increased,” it becomes challenging for the public to validate that claim. The posted information often lacks clarity.
To be fair, hospital expenses are high in many regions, certain medications are exorbitantly priced, and healthcare worker salaries have risen. These factors are reflected in the math. But if insurance companies are seeking substantial increases in rates, they need to provide clear public proof showing the reasons behind those costs: how much is due to increased usage, deviations from past projections, and any impacts from policy shifts like subsidy expirations. If they can’t substantiate it, they shouldn’t impose it.
Insurers argue that medical loss ratios prevent excessive charges since most premiums are allocated to treatment funding. However, if premiums rise, that 80 to 85 percent figure will also increase in absolute terms, leading to higher administrative costs and profits as well.
The most concerning strategies remain visible. The aim should be to extend subsidies to prevent premium hikes, but doing so might merely divert attention from the fundamental causes of rising healthcare costs and exploit public fear as a lobbying tactic. This approach is currently at the heart of the spending deadlock in Washington, which blames the government shutdown on Democrats pushing for more expansive Obamacare subsidies.
It’s noteworthy that the very Senate handling the shutdown is the same place where a significant bipartisan price transparency bill, which had already passed the House, never got a vote. The Reduce Costs and Increase Transparency Act passed the House with a solid majority on December 11, 2023, but the 118th Congress ended without any discussion in the Senate. If they can halt the government over subsidies, surely they could spare an hour to vote on a bill aimed at making prices clear to patients.
Using a government shutdown as leverage for subsidies, while obscuring price transparency, is a regressive approach. It benefits lobbyists, not families.
There is, however, a much better alternative that prioritizes the needs of the people. When insurers request regulators to raise premiums significantly, they must make their case publicly—not through complex documents—but in straightforward language with clear numerical backing.
If a plan depends on federal assistance, then they should provide two rates: one that includes the subsidy and one that doesn’t. Both rates should be displayed side by side so that everyone can understand who is covering what, and how much. Major assumptions about pricing necessitate independent verification, particularly regarding hospital contracts and the costs of high-priced drugs. Furthermore, if a company asserts “instability” as a reason for price increases, that justification should be based on actual recent bill increases, rather than vague threats.
None of this denies the reality of high medical expenses. Yet, premium hikes should occur for clear, documented reasons—not be wielded as a bargaining chip. If stability is the goal, Washington shouldn’t hand out blank checks. There should be transparency and enforcement allowing everyone to scrutinize the calculations and trust the results.
Ultimately, what families care about is how much they need to pay each month. If their expenses increase rapidly, they deserve a sincere explanation tied to actual data, not politically motivated threats. Insurance should focus on sharing risks, not exerting power. Illuminate the details, show the work behind the numbers, and rebuild trust.
