By Sabrina Corlette, Kevin Lucia, and JoAnn Volk
The results are in, the voters have spoken, and the message couldn’t be more clear: Policymakers need to be laser-focused on the cost of living, particularly the high cost of health care. For almost two years, advocates for affordable, high quality health coverage have been on defense, attempting to block $1 trillion in cuts to federal health care programs, restore enhanced Marketplace premium tax credits (PTC), and halt destructive executive branch rules that would raise costs and increase red tape for millions of Marketplace and Medicaid enrollees. These efforts have left little space for a proactive, forward-looking agenda to make health coverage work for everyone. That changes now.
Today, 81 percent of people with employer-sponsored insurance – long considered the gold standard of coverage – report that health care is unaffordable. One-third of people with private insurance hold medical debt. In the wake of the 2025 budget reconciliation bill and the termination of enhanced PTCs, millions of Marketplace enrollees are paying 58 percent more for premiums and 37 percent more in deductibles.
In the wake of the 2026 midterm elections, the newly elected Congress has an opportunity to play offense on health care and craft an agenda that delivers immediate, meaningful affordability relief to the American people. As a first order of business, that means rolling back cuts in federal health care funding. Almost 15 million people are projected to lose their health insurance if the cuts imposed by H.R. 1, the 2025 budget reconciliation bill, are allowed to go into effect, and the enhanced PTCs are not restored. Reversing the Medicaid and Marketplace funding cuts needs to be priority number one for the new Congress.
But restoring the status quo will not be enough. Congress needs to advance policies that meaningfully lower health care costs for people. This means focusing on the underlying drivers of health care cost growth in the U.S. There is broad consensus on what those top cost drivers are: (1) hospital prices and (2) drug costs. As these costs have risen health plans have responded by shifting more costs onto families in the form of higher premiums, deductibles, and aggressive prior authorization. Meanwhile, rampant vertical integration, private equity, and an ever-expanding web of industry middlemen are pushing health costs up even higher.
A congressional agenda that focuses on health care affordability needs to both improve the value of insurance coverage and constrain the underlying drivers of health care cost growth. This means advancing reforms that lower consumers’ out-of-pocket costs for critical health care services and alleviating major pain points for patients and clinicians, such as aggressive use of prior authorization to deny care. It also means lowering hospital system and drug prices and cracking down on egregious billing and collection practices, reining in the profit-extracting practices of insurers, health care systems and providers, and a growing array of administrative and financial middlemen that add complexity, engage in self-dealing, and drive up costs. These reforms should be informed by lessons from successful state innovations to improve the affordability of health care.
Voters expect their new slate of policymakers to relieve them from the crushing costs of health care and hold health industry stakeholders accountable. We at the Center on Health Insurance Reforms (CHIR) stand ready to assist in that effort.
