Sky-High Insurance Premiums Spell Trouble for the U.S. Health Care System

Americans are facing some of the highest health insurance premiums ever. At the end of 2025, Affordable Care Act enhanced subsidies expired, leading some monthly premiums to double. Patients with employer-sponsored plans, too, have felt the pain of rising prices. The average family now pays $26,993 a year on employer-sponsored health plans, a 6% increase from 2024. Even for my own practice, our premiums increased 27% this year for identical coverage.

This has led many Americans to skimp on their health insurance coverage — or forgo it altogether.

That can be disastrous for patients like the ones I treat, who live with complex and chronic autoimmune diseases like rheumatoid arthritis, lupus and psoriatic arthritis. If patients drop their coverage, they may put off doctor’s visits or ignore their symptoms — and managing these rheumatic conditions will only grow more difficult.

The Tipping Point

I understand all too well how patients got to this point. As premiums have been steadily rising, their ability to access care has been steadily decreasing.

Take prior authorizations. Nearly half of rheumatic patients face prior authorization requirements that delay treatment and worsen outcomes. The delays are worse for infusible biologics, some of the most effective treatments we have, where patients often wait weeks before receiving their first dose. Many are also forced to “fail” a cheaper, insurer-preferred drug before I can prescribe a treatment deemed most effective for a particular patient. The result is patients may suffer longer — and unnecessarily — while paperwork gets sorted.

I’ve been in practice for over 30 years. I know the headaches of insurance — their confusing explanations of benefits, opaque pricing, utilization management barriers — but it seems that we may be at a tipping point.

The cost for even the most basic coverage is too high, and some Americans are opting out.

Patients Want to Feel Empowered

Faced with a system that feels designed to exhaust them, patients are finding their own way around.

Direct-to-consumer health services have taken off, including at-home lab testing and medications shipped directly from manufacturers. The ease of access and up-front pricing that these services offer have helped patients budget their health expenses and circumvent the hassle of insurance requirements. Between these on-demand treatment options, wearables that track symptoms in real time and virtual appointments, patients can now be diagnosed and managed without ever stepping foot in a clinic. For my patients with chronic conditions who can experience flares without warning, these instant care options are invaluable.

Artificial intelligence has entered the exam room too. Many of my patients arrive having already consulted AI about their symptoms. I welcome an informed patient, but I’m also realistic. These tools are imperfect and, in a field as nuanced as rheumatology, they are no substitute for clinical judgment. What their popularity tells me is that patients, worn down by the bureaucracy of insurance, are desperate to have agency in their own care.

The Consequences of Expensive Premiums

As premiums rise and barriers multiply, patients are making an impossible calculation: Pay for coverage that doesn’t guarantee care or go without and risk being blindsided by an emergency. While some have no choice but to forgo insurance, others are willingly taking the gamble.

These trade-offs are not wholly unfamiliar to Americans; many make choices on their health plans and their deductibles with limited information. It doesn’t help that many insurance prices aren’t rooted in reality. When navigating care for back pain recently, I paid out of pocket for an MRI, which totaled $669. If I had used my insurance, it would have cost $2,500.

But the consequences of more Americans dropping coverage will be stark. When uninsured patients delay preventive care, skip appointments and start rationing medication, the impacts ripple outward. Conditions go unmanaged. Diagnoses come later and patients may grow sicker. Emergency rooms and urgent care facilities absorb what primary and specialty care should have caught months earlier. The costs don’t disappear. They multiply.

Conclusion

Health insurance was sold to Americans as a necessary tool to access care. To the average patient, that means readily available preventive care and assurance that an emergency won’t break the bank. But if premiums continue to rise, the gap between what the system provides and what it costs will continue to widen. Patients will opt out, and their health will suffer.

The consequences of these high insurance premiums will reverberate throughout the health care system. Physicians see it. Patients live it. And at some point, insurers need to reckon with it too.

Joseph Eugene Huffstutter, M.D., is a rheumatologist based in Hixson, Tennessee.