The purpose of health insurance is to help families, not threaten them. Yet, when big insurers, or their lobby in Washington, don’t get the policy results they want, they turn to the same lever: higher premiums.
He doesn’t care. That’s pressure – and patients feel it first.
We have seen this before also. In October 2017, the administration cut off Cost-Sharing Deduction Payments. Carriers responded by “silver-loading” the following year, accumulating the missing dollars. silver plansAnd as analysts had warned, premiums soared. Kaiser Family Foundation Document the change; The Congressional Budget Office said the payments will end Increase silver premium by about 20 percent In 2018, federal costs are rising through larger tax credits.
now look what’s happening Proposed For next year. For 2026, Marketplace filings show the largest proposed increases since that shock — an average of 18 percent, with carriers citing hospital prices, utilization, costlier GLP-1s and the risk of enhanced Affordable Care Act tax credits expiring. Both Kaiser and health system trackers flag the subsidy question in their filings, and national outlets link to the same credits The current budget impasse in Washington,
Rates aren’t magic – they’re math. In a functioning market, you start with recent claims and unit prices, then move forward. we also made railing, With prior review of major hikes and medical loss ratioThat says plans must spend 80 to 85 percent of premiums on care or pay deductibles. But those tools only work when they are implemented and visible.
Visibility is the problem. Public actuarial memos are frequently revised; Key tables are blacked out as “trade secrets”. Regulators can see the big picture, but families and journalists usually don’t. If a carrier says “costs went up,” the public can’t simply repeat the math based on what Posted,
To be fair, hospital prices are high in many markets. Some medicines are very expensive. The salaries of health workers have increased. Those forces are bound to show up in mathematics. But if a company wants double-digit growth, it must show clear evidence publicly of how much comes from higher costs, how much from higher utilization, how much from last year’s missed forecasts and how much from policy changes, such as expiring subsidies. If you can’t show it, you shouldn’t charge for it.
Insurers want to answer that the medical loss ratio prevents injury because most premium dollars have to fund care. But if premiums go up, 80 to 85 percent of the big number is still big. Total dollars increase, and allowed administrative costs and the share of profit increase in absolute terms.
The worst move is the one we keep seeing clearly: Increase subsidies to keep premiums from rising. This will only divert attention from the real drivers of costs and turn public fear into a lobbying tactic. For now, that strategy is at the center of Washington’s spending standoff, Democrats accused of shutdown Demand to extend increased Obamacare subsidies.
What should bother everyone is that the shutdown is being led in the same Senate chamber that has never voted on a major bipartisan price-transparency bill that has previously passed the House. Lower Costs, More Transparency Act cleaned the house320 to 71 on December 11, 2023, but the 118th Congress ended without Senate deliberations. If the Senate can block government subsidies, surely it can give it an hour to vote on letting patients see prices.
Using shutdowns as leverage to subsidize while eliminating price transparency is backwards. It helps lobbyists, not families.
There is a better way that puts people first. If an insurer asks regulators for a big premium increase, it should show its work publicly, with the numbers accompanied by plain English explanations, not a redacted PDF.
If a plan depends on federal subsidies, it must file two rates – one with the subsidy, one without – and publish both side by side so everyone can see who is loading what and how much. Big assumptions about prices should come with independent scrutiny, especially for hospital contracts and high-cost drugs. And when a company blames “volatility,” the increase in filings should be based on actual recent claims, not vague warnings.
None of this is to deny that health care can be expensive. But premiums should increase for clear, proven reasons – not as a trade-off. If Washington wants stability, it should not write blank checks. should fund it Transparency and enforcementSo that everyone can see the math and trust the results.
Families care about one thing most: the amount they pay every month. When these numbers increase, they deserve an honest explanation based on real history, not a threat based on politics. Insurance should aggregate risk, not power. Spread the light, show the work and restore trust.
David Balat is the CEO of The Direct Care Alliance.
