Americans facing ‘really tough decisions’ around rising health insurance costs
In an interview with WBUR, Harvard T.H. Chan School of Public Health’s Adrianna McIntyre discussed rising health care costs and offered perspective on common ways Americans are trying to cope.
McIntyre is an assistant professor of health policy and politics in the Department of Health Policy and Management. Here are highlights from the Oct. 15 interview:
On health insurance costs increasing—particularly through the Affordable Care Act (ACA) Marketplace:
Every year, employers and other sources of health insurance, [like] Medicare and the ACA Marketplace, change up what they offer for health insurance. And this … is a year where we’re expecting to see particularly high premium increases. That’s in part due to the underlying costs of care going up. And so, individuals who are choosing their [health insurance] plans for the new year really need to think about how they want to balance the monthly premium costs with those out-of-pocket costs at point of care, like deductibles or co-pays.
Unfortunately, [it was] fairly common, as we moved from 2025 to 2026, [for ACA Marketplace health insurance premiums go up significantly]. At the end of 2025, something that experts call the enhanced premium tax credits—the enhanced subsidies for the ACA—expired. So there were some people who were in the marketplace who lost all of the financial assistance that they had been entitled to before. And for those people, premiums just skyrocketed, and there’s not really relief, because there just isn’t subsidy for them to tap into unless their income falls dramatically, which obviously is its own form of a bad outcome.
On more Americans choosing to disenroll from health insurance entirely:
These are really tough decisions that people have to grapple with, and part of the issue is that you don’t know, looking into the future, how much health care you’re going to need. If you think about how people use health care in the United States, imagine a room full of 100 people. In that room full of 100 people, five of them will account for 50% of [U.S.] health care spending. But you often don’t know in advance if you’re going be one of those five people—somebody who has a complicated pregnancy and a baby in the NICU, or somebody who has a car crash with a complicated recovery. [If you put] aside what you would pay for your premium into a savings account … that will get you some ways with your primary care, maybe even your urgent care visits. But if you have a real emergency, that’s not going to be enough.
On the complicated process of deciding on a new insurance plan:
There are folks available to help with enrollment in the context of the ACA Marketplace. They’re known as navigators, and folks can look up local resources in their area on healthcare.gov or on their state-based marketplace. Most people these days receive some sort of assistance when they enter the marketplace, because people often have dozens of plans to choose from. [Navigators] can be helpful in determining what is it that you should be prioritizing given your health needs.
On using artificial intelligence to help decide on a new insurance plan:
AI is … an imperfect tool, so I would double-check anything that you’re [reading] there. If ChatGPT says your doctor is in network for a plan, I would probably give your doctor a call and make sure that that’s right, because the AI could be working off of old or bad information. So, I wouldn’t necessarily discourage folks from doing it, but I would say to proceed with caution.
Listen to the interview:
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