Healthcare Catch-All | Medicare changes 2026

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The current shutdown is in part about healthcare insurance access and GOP cuts to healthcare programs, so it seemed like we could use a thread to discuss the barriers to healthcare access and spiraling insurance premiums & healthcare costs for Americans.

 

Individual market insurers requesting largest premium increases in more than 5 years​


www.healthsystemtracker.org

Individual market insurers requesting largest premium increases in more than 5 years - Peterson-KFF Health System Tracker

Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018, the last time policy uncertainty contributed to sharp premium increases. Across 105 ACA Marketplace insurers in 20 markets (19 states and the District of Columbia)...
www.healthsystemtracker.org www.healthsystemtracker.org

“… Some of the factors that insurers cite as contributing to higher rates next year include:

  • Enhanced premium tax credits that make coverage more affordable will expire at the end of 2025, driving up out-of-pocket premium payments by over 75% on average. This is expected to cause healthier enrollees to drop their coverage and create a sicker risk pool. An earlier Peterson-KFF Health System Tracker analysis showed the expiration of enhanced premium tax credits raised proposed rates by an additional 4 percent, on average.
  • Tariffs could drive up the cost of some drugs, medical equipment, and supplies. Some insurers report that tariffs—and the uncertainty around them—are driving rate increases about 3% higher than they otherwise would be.
Additionally, many insurers submitted proposed rates before the budget reconciliation legislation passed and the Centers for Medicare and Medicaid Services (CMS) finalized the Marketplace Integrity and Affordability rule. The legislation and rule make changes to how the Marketplaces operate and how people are enrolled. These changes were only finalized in early July and late June, respectively, and it is not yet clear how insurers may respond.…”
 

Employers prepare for the highest health benefit cost increase in 15 years​


www.mercer.com

Employers prepare for the highest health benefit cost increase in 15 years

If employer health plan sponsors hoped that 2026 would bring some relief from the recent upward trend in cost growth, they are now having to face up to a very different reality.
www.mercer.com www.mercer.com

“… The total health benefit cost per employee is expected to rise 6.5% on average in 2026 — the highest increase since 2010 — even after accounting for planned cost-reduction measures. Employers estimated that plan cost would increase by nearly 9%, on average, if they took no action to lower cost.

… Health benefit cost trend has two primary components — the price of healthcare services and the rate of utilization — and right now, both are rising.

Some price pressures are ongoing. Advances in diagnostics and therapeutics, such as cancer treatments and weight-loss drugs, produce better outcomes. However, they typically cost more than the treatments they replace. In addition, the continuing consolidation of providers into fewer, larger health systems has improved their ability to work with insurers in setting reimbursement levels. More recently, inflation across the general economy, including higher wages in the healthcare sector, has contributed to price increases. In addition, according to industry reports, the introduction and buildout of AI-based platforms that help providers optimize billing may be another source of pressure on healthcare spending.

Utilization rates for various health services have been rising over the past two years. The lingering effect of delayed or missed care due to the COVID-19 pandemic is likely a factor. Constraints on the healthcare labor supply have eased, including through the use of AI in provider offices, which saves time and increases capacity. At the same time, the rise of virtual healthcare — and growing consumer acceptance of it, particularly in behavioral health — is also affecting utilization patterns because it removes geographic barriers to care and can be a more convenient option for patients.

Employers’ response to faster cost growth

The survey found that 59% of employers will make cost-cutting changes to their plans in 2026 — up from 48% making changes in 2025 and 44% in 2024. Generally, these involve raising deductibles and other cost-sharing provisions, which can lead to higher out-of-pocket costs for plan members when they seek care.…”
 
So here is a project-worthy of a federal grant
Take an MD -hopefully a Hospital Specialist. A couple of AI nerds. A hospital finance expert
Pick a nice size hospital-hey UNC Health Care
Aggregate all costs, Bills, total revenue
Look at what you get to spit out
Why the hell is everything so expensive?
Are there alternatives that provide care-at a lower cost???
One key I suppose is once you identify the real cost drivers-tinker with AL to guess " are they worth it?"
 
mpaer said:
So here is a project-worthy of a federal grant
Take an MD -hopefully a Hospital Specialist. A couple of AI nerds. A hospital finance expert
Pick a nice size hospital-hey UNC Health Care
Aggregate all costs, Bills, total revenue
Look at what you get to spit out
Why the hell is everything so expensive?
Are there alternatives that provide care-at a lower cost???
One key I suppose is once you identify the real cost drivers-tinker with AL to guess " are they worth it?"
Click to expand...
I hear you that AI could maybe help with this, but we know from many, many high quality studies why healthcare in the US is so expensive and what could be done to address it. For example —

Healthcare Spending: Plenty of Blame to Go Around - PMC

pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

hsph.harvard.edu

Understanding why health care costs in the U.S. are so high | Harvard T.H. Chan School of Public Health

The high cost of medical care in the U.S. is one of the greatest challenges the country faces and it affects everything from the economy to individual
hsph.harvard.edu hsph.harvard.edu

It’s the Prices, Stupid: Why the United States is So Different from Other Countries - PMC

pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

www.aamc.org

Health Care Costs: What’s the Problem?

What costs are too high, and can they be controlled through policy while improving access to care and the health of the population?
www.aamc.org www.aamc.org
 
our healthcare is a con and embarrassment. seeing all those big pharma commercials pushing their latest poisons on every channel should be illegal but america is so goddamn stupid that they eat it up. saw one this morning for a drug that 'treats' involuntary movements that their poisonous psychiatric drugs cause. what a goddamned dumbed down society we live in.
 

Big Changes Are Coming for 2026 Medicare Plans. What You Need to Know.​

Skinnier benefits, higher premiums and fewer options mean more than a million seniors should shop for new coverage during open enrollment​


🎁 —> https://www.wsj.com/health/healthca...5?st=XjCQno&reflink=desktopwebshare_permalink

“… The upshot: Seniors have to be careful, or they might end up with a bad surprise such as higher drug costs or the loss of a favorite doctor.…”
 
OGtruthhurts said:
our healthcare is a con and embarrassment. seeing all those big pharma commercials pushing their latest poisons on every channel should be illegal but america is so goddamn stupid that they eat it up. saw one this morning for a drug that 'treats' involuntary movements that their poisonous psychiatric drugs cause. what a goddamned dumbed down society we live in.
Click to expand...
Yes, you’re right. Much better to leave psychiatric conditions untreated than to have to deal with minor side effects.
 
OGtruthhurts said:
our healthcare is a con and embarrassment. seeing all those big pharma commercials pushing their latest poisons on every channel should be illegal but america is so goddamn stupid that they eat it up. saw one this morning for a drug that 'treats' involuntary movements that their poisonous psychiatric drugs cause. what a goddamned dumbed down society we live in.
Click to expand...
Im not trying to be personal, but you don't come off as someone who should be lecturing about the values or lack of values of psychiatric drugs. If your board persona is reflective of your actual persona, it doesnt scream "well adjusted".
 
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