{"id":77829,"date":"2025-12-05T20:38:50","date_gmt":"2025-12-06T04:38:50","guid":{"rendered":"https:\/\/lapost.us\/?p=77829"},"modified":"2025-12-05T20:38:50","modified_gmt":"2025-12-06T04:38:50","slug":"congress-can-fix-skyrocketing-health-care-costs-but-will-it","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=77829","title":{"rendered":"Congress Can Fix Skyrocketing Health Care Costs: But Will It?"},"content":{"rendered":"
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By<\/span>Sunita Sohrabji<\/a><\/div>\n<\/div>\n<\/div>\n
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Healthcare costs will skyrocket in 2026, as millions of consumers face a 100% increase in their monthly premiums.<\/p>\n<\/div>\n<\/div>\n

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(Marek Studzinski representational image via Unsplash)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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The Senate Dec. 11 will vote to continue the Affordable Care Act\u2019s Enhanced Premium Tax Credits, potentially bringing relief to millions of ACA consumers who have seen their monthly premiums double for 2026.<\/p>\n

Enhanced premium tax credits are currently set to expire at the end of December. Senate Democrats have proposed a \u201cclean\u201d 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.<\/p>\n

More than 24 million people buy their health insurance on the ACA marketplace; 92% qualify for EPTCs.<\/p>\n

Dropping Off Healthcare<\/h2>\n

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 $3000.<\/p>\n

\u201cWe are seriously thinking of dropping our insurance altogether, although we probably won\u2019t.\u00a0We\u2019re doing our best to get all necessary tests and doctor visits done before Dec. 31,\u201d 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.<\/p>\n

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. \u201cWe 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,\u201d he said, at a Nov. 21 American Community Media news briefing.<\/p>\n

Price Increases for All Consumers<\/h2>\n

Bednar predicted that health care costs would rise for all consumers. \u201cIn 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 \u2014 who are more likely to have access to coverage through Medicaid \u2014 you by definition increase the overarching pressure on the payers, whether that\u2019s government-sponsored payers, or whether that\u2019s commercial payers.\u201d<\/p>\n

HR 1 \u2014 also known as the One Big Beautiful Act passed by Congress late summer \u2014 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.<\/p>\n

In California, Medicaid is known as MediCal.<\/p>\n

2026 will also be the first year that Medicare will negotiate drug pricing. Bednar noted that negotiations began under the Biden Administration\u2019s Inflation Reduction Act, which was successful in negotiating prices for 15 medications, including those addressing diabetes, heart and kidney disease, and certain cancers.<\/p>\n

Drug Pricing<\/h2>\n

\u201cDrug pricing remains one of the hard to characterize topics of conversation in health policy,\u201d said Bednar, noting there have been meaningful reforms in the Biden and Trump Administrations.<\/p>\n

The Trump Administration has not repealed the negotiations. \u201cImplementation has carried on largely unaffected by this administration,\u201d said Bednar. \u201cMoreover, 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.\u201d<\/p>\n

\u201cThe 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\u2019ve 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,\u201d he said.<\/p>\n

Affordable Healthcare<\/h2>\n

At the Nov. 21 news briefing, Sophia Tripoli, senior director of health policy at Families USA, laid out her organization\u2019s vision for more equitable and affordable healthcare.<\/p>\n

\u201cWe 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\u2019re forced to choose between medical care and groceries,\u201d said Tripoli.<\/p>\n

\u201cHealth care prices are being pushed higher by two structural forces that have little to do with the health of the American people. It\u2019s corporate consolidation and payment incentives that reward volume over value,\u201d she said, noting the consolidation of forces that are the backbone of health care in America.<\/p>\n

Consumers Not Getting Better Care<\/h2>\n

\u201cWhen 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\u2019t get better care. Instead, we get higher premiums, higher deductibles, and confusing bills that bear no relationship to the cost of providing care,\u201d said Tripoli.<\/p>\n

\u201cThe system rewards doing more, not doing better. It rewards expansion, not efficiency, and it certainly doesn\u2019t reward prevention or the financial security of families.\u201d<\/p>\n

Congress has the ability to reform health care accessibility and affordability, said Tripoli. She offered several actions Congress could take, including:<\/p>\n