As lawmakers debate ACA subsidy extensions and HSAs tied to banks and insurers, the public’s appetite for a health care overhaul is stronger than at any time since the 2020 Democratic primaries.
Washington is running out of hours to address the health care crisis of their own making. There are just 23 days before the Affordable Care Act’s (ACA) enhanced subsidies expire and congressional leaders are still trading barbs and floating half-baked ideas as millions of Americans brace for punishing premium spikes.
Meanwhile, the public has grown frustrated with both congressional dysfunction, and private health insurance companies that continue to raise premiums and out-of-pocket costs at a dizzying pace. According to new KFF data, 6 in 10 ACA enrollees already struggle to afford deductibles and co-pays, and most say they couldn’t absorb even a $300 annual increase without financial pain.
And even as Congress flails, Americans are coalescing around a solution party leaders rarely mention: Medicare for All.
A dramatic rebound in popularity
After Senator Bernie Sanders bowed out of the presidential race in April 2020, Medicare for All faded to the background following political infighting, industry fearmongering and the lack of a national champion. But nearly six years later, the proposed policy solution has re-emerged as a top choice among frustrated voters.
A new Data for Progress poll found that65% of likely voters (including 71% of independents and nearly half of Republicans) support creating a national health insurance program that would replace most private plans. What’s notable is that the poll shows that support barely budges – holding at 63% – even when voters are told Medicare for All would eliminate private insurance and replace premiums with taxes, a dramatic shift from years past when just 13% supported such a plan under those conditions.
The KFF poll shows that ACA enrollees lack confidence that President Trump or congressional Republicans will handle the crisis, with almost half of ACA enrollees saying a $1,000 cost spike would “majorly impact” their vote in 2026. Morethan half of ACA enrollees are in Republican congressional districts, which explains why Republicans representing swing districts are desperately trying to persuade their Republican colleagues — so far without success — to extend the subsidies.
Of course, Medicare for All still faces steep odds in Congress. Industry opposition remains powerful, Democrats are divided and Republicans are openly hostile. But the polling shift is significant and suggests the political terrain is changing faster than Washington is acknowledging — and that voters, squeezed by soaring premiums and dwindling subsidies, are being nudged toward policies previously attacked as too ambitious to pass.
And against this backdrop, Medicare for All’s revival feels less like a left-wing wet dream and more like a window into the public’s thinning patience. Americans are looking past the Affordable Care Act’s limits and past Big Insurance’s promises – and towards a solution that decouples Americans health from profit-hungry, Wall Street-driven corporate monsters. While Washington has met this moment with inaction, Americans seem ready to act.
The Trump administration is shaking up how health systems are paid for outpatient care with a plan that could reduce Medicare hospital spending by nearly $11 billion over the next decade.
Why it matters:
It’s a big step forward for “site-neutral” payment policies that have been touted as a way to save taxpayers and patients money, but that hospitals say will lead to service cuts, especially in rural areas.
Driving the news:
Medicare administrators on Friday finalized a proposal to reduce what the government pays hospitals to administer outpatient drugs, including chemotherapy, at off-campus sites.
The move would equalize payment rates to hospitals and physician practices for the same services — an idea that Congress debated last year but didn’t act on in the face of aggressive hospital lobbying.
Medicare now pays about $341 for chemotherapy administration in hospital outpatient facilities, compared with $119 for the same service delivered in a doctor’s office.
Medicare next year will also start to phase out a list of more than 1,700 procedures and services only covered when they’re delivered in an inpatient setting.
What they’re saying:
The policy changes will give seniors more choices on where to get a procedure and potentially lower out-of-pocket costs at an outpatient site, the Centers for Medicare and Medicaid Services said.
Some health policy experts said the change will help make Medicare more affordable.
“We hope the administration will continue its efforts and adopt site neutrality for other services in future rules,” Mark Miller, executive vice president of health care at Arnold Ventures, said in a statement.
The other side:
“Both policies ignore the important differences between hospital outpatient departments and other sites of care,” Ashley Thompson, a senior vice president at the American Hospital Association, said in a statement.
“The reality is that hospital outpatient departments serve Medicare patients who are sicker, more clinically complex, and more often disabled or residing in rural or low-income areas than the patients seen in independent physician offices.”
Hospital outpatient departments still will see an $8 billion overall increase in their Medicare payments in 2026.
But the Trump administration contends that new technologies and other factors are shortening recovery times for procedures done on an outpatient basis.
Between the lines:
Health systems still scored a small win when CMS dropped a plan to speed up the repayment of $7.8 billion in improper cuts the first Trump administration made to safety-net providers’ reimbursements in the federal discount drug program.
The policy would have clawed back the money from hospitals’ Medicare reimbursements. Scrapping the idea “helps preserve critical resources for patient care during an already challenging time,” Soumi Saha, senior vice president of government affairs at Premier, said in a statement.
Still, CMS said it may try again in 2027. And law firm Hooper Lundy Bookman is already sending out feelers to hospitals willing to challenge the version of the repayment plan that will go into effect next year, per an alert sent Friday night.
What we’re watching:
Whether health systems challenge the site-neutral payment changes. The hospital payment plan came weeks later than expected and will make it harder for facilities to update billing, revise their budgets and train staff, Saha said.
The administration is also launching a survey of hospitals’ outpatient drug acquisition costs next year, which is seen as a prelude for cutting reimbursements under the discount drug program.
A Florida retirement haven is thrown into chaos as a $360 million Medicare overbilling scandal and a Humana–UnitedHealth standoff leave seniors scrambling to keep their doctors.
Behind the gates of The Villages (the pastel Shangri-La of Florida retirement lore) is a place where American seniors zoom around on golf carts like 1977 Thunderbirds and keep wrist stabilizers on the ready for impromptu pickleball matches. It’s a community built on the promise that retirement is a time for sunshine, camaraderie and — most importantly — a health system that doesn’t leave you out in the cold.
HEALTH CARE un-covered has published stories about The Villages in the past – and how the retirement community is rife with Medicare Advantage shenanigans. And today, many Villagers have been blindsided by these shenanigans like they’re part of a Big Insurance hostage crisis straight out of an episode of Days of Our Lives or General Hospital.
A TVH / UnitedHealth dispute leaving seniors “duped”
Earlier this year, The Villages Health (TVH) — the health system serving more than 55,000 retirees — promised a smooth handoff as it prepared to sell itself to CenterWell, Humana’s senior-focused primary-care chain. TVH’s CEO assured residents that “no change in care” was coming, according to News 6.
But then came the bankruptcy filing. And then the revelation that TVH owed more than $360 million to the federal government for “Medicare overbilling.” And then the sale. And, according to Village-News, then a bankruptcy judge confirming that, yes, TVH was indeed being swallowed by CenterWell for $68 million.
In other words: the health care version of a soap-opera plot twist. Only with fewer glamorous outfits and more Chapter 11 filings.
On November 7, the very day the sale of TVH closed, patients received a message warning them that their UnitedHealthcare Medicare Advantage plan — the plan they were nudged toward back in 2016 when TVH tried to push all patients into UnitedHealth’s grasp — might not be accepted after Dec. 31, 2025. If negotiations fail, residents must switch doctors or switch insurers.
Message from The Villages Health to their “Valued Patient(s)”.
“Not to be notified until basically the last minute that there isn’t a contract between CenterWell and United at this time is very alarming,” Villager Phyllis McElveen told Spectrum News. “We had already gone out and selected our UnitedHealthcare plan for 2026. We had already done everything. And now to know we might have to make a change is just not a pleasant feeling.”
At The Villages, you can imagine that picking the right Medicare plan is akin to competitive sport — one step removed from a pickleball tournament. The residents do their homework and many reportedly attend “Medicare prep presentations.” So for Villagers, being blindsided is a big deal.
Longtime patient Nancy Devlin told News 6 that she dug through Humana’s and Aetna’s plans to find a plan that might allow her to stay with the physicians she’s seen for six years. But for Devlin, her digging was to no avail. None of the plans matched what she currently had with UnitedHealthcare. Not the same covered medications. Not the same premiums. Not the same out-of-pocket costs. Not the same networks.
“They duped us,” she said. “It’s more expensive and doesn’t have my medications, or I have to pay for them, and I don’t pay for my medications now.”
For retirees on limited incomes, doubling drug costs is a gut punch that can mean one less trip to visit their grandkids or postponing that cruise to the Bahamas. Or for some, putting enough food on the table.
A deal gone sour
To understand how this crisis happened, go back to 2016, when TVH urged residents to switch into UnitedHealthcare Medicare Advantage or lose access to their doctors. Fast-forward to today. TVH is bankrupt, Humana now owns the centers, and UnitedHealth, the world’s largest health conglomerate (and the once-preferred partner for Villagers) is persona non grata unless a deal is reached.
The timing could not be worse. Open enrollment ends December 7, which means that tens of thousands of retirees have just around two weeks to decide whether to switch insurers or switch doctors.
What’s happening here is not simply a contract negotiation gone awry, but a symptom of something deeper. TVH didn’t just owe “some money” to Medicare. It owed about $360 million because of what Humana and The Villages described as a gigantic “Medicare coding error.”
UnitedHealthcare, in turn, accused The Villages’ controlling Morse family of quietly pulling out $183 million between 2022 and 2024 – funds UnitedHealth argued were siphoned off just before the bankruptcy filing.
If that allegation sounds familiar, it’s because we’ve seen versions of this story across the health care industry: private companies treating Medicare Advantage plans like piñatas stuffed with taxpayer dollars. Sometimes, the bat misses the piñata and smacks a whole village of seniors.
Here’s what happens next
The Villages, for all its mid-century charm and retirement-resort quirks, is a microcosm of a national problem that Medicare Advantage is, too often, run for Big Insurance’s advantage with seniors just an afterthought. Corporate acquisitions, bankruptcies, risk-coding schemes, contract disputes and Wall Street demands that lead to fewer and fewer in-network doctors and hospitals and covered drugs. Meanwhile, billions in taxpayer dollars flow through this system with relatively no accountability. Medicare Advantage is corporate welfare on steroids, with the “invisible hand” of the market misleading and then slapping the hell out of vulnerable American seniors to enrich the big guys in control with cushy government handouts.
For Villagers, it’s either/or:
Either CenterWell and UHC strike a deal: The crisis cools, residents keep their current doctors in 2026.
Or no deal is reached: Tens of thousands will either change doctors, change plans or risk being turned away at medical appointments starting Jan. 1, 2026.
Representative Mark Pocan (D-WI) yesterday introduced eight bills aimed at strengthening traditional Medicare and reining in some of the worst practices in the privately-run Medicare Advantage business. For years, lawmakers have danced around the mounting evidence that private Medicare Advantage plans overbill taxpayers between $80 and $140 billion annually and quietly impose barriers to seniors’ care to boost profits.
Traditional Medicare remains one of the most successful public programs in American history. It was built around a simple promise: If your doctor says you need care, you get it. But as Medicare Advantage has grown, that promise has eroded for millions of people. MA plans are largely run by big insurance conglomerates – like UnitedHealthcare, Elevance and CVS/Aetna – and those insurers decide what care is covered, which doctors you can see and how long you can stay in a hospital. Each cent they have to shell out for your care is a cent they can’t keep in their pockets or split with their shareholders. Wall Street’s relentless demand for more and more of that money incentivizes them to deny or delay care that mean life-and-death for millions of American seniors.
And it’s not just health care policy nerds like me that have been focused on this issue – even the U.S. Department of Justice (DOJ) has taken aim at Medicare Advantage. In February, news broke that the DOJ had launched a civil fraud investigation into UnitedHealth Group, the largest MA insurer, for the company’s alleged use of diagnoses that trigger higher Medicare Advantage payments. And in July, the company confirmed it is the subject of a DOJ criminal investigation. The DOJ reportedly questioned former UnitedHealth Group employees about the company’s business practices.
You can see the entire package of bills on Pocan’s website. They include the Denials Don’t Pay Act, which would force Medicare Advantage plans to face real consequences if too many of their prior-authorization denials are overturned; The Right to Appeal Patient Insurance Denials (RAPID) Act, which would ensure every denial is automatically appealed, sparing sick and elderly patients from navigating a process many never even know exists; and the Protect Medicare Choice Act which would stop insurers and brokers from pushing seniors into Medicare Advantage by default.
Pocan and his co-sponsors understand that Medicare Advantage’s prior authorization hurdles and widespread denials are just Wall Street-directed obstacles that second-guess physicians and delay care. Patients pay the price. Doctors pay the price. And taxpayers pay the price.
More Perfect Union has just posted a video breaking down a truth that Big Insurance hopes you never hear: rising “health care costs” are really rising health insurance profits.
As I explained in the video, UnitedHealth, Cigna, CVS/Aetna are part of a cartel of corporate conglomerates that have built a business model that relies on overpayments in Medicare Advantage, shrinking doctor networks and a sprawling web of vertically integrated subsidiaries that vacuum up our premiums, deductibles and tax dollars — and turn them into shareholder returns as Wall Street relentlessly demands.
Here’s a bit of what I said:
“Your premiums, deductibles and pharmacy bills are all going up. We’re told it’s because medical costs are rising, but the bigger story is who’s capturing the money. In just three months, UnitedHealth Group made $4.3 billion in profits on revenues of $113 billion.
Over the past five years, the cost of a family premium has increased 26%. This year, the average cost of a family policy was almost $27,000.
Just about everybody with private insurance will be paying a lot more than that next year, regardless of whether you get it from your employer or buy it on your own. That’s because UnitedHealth and other big insurance companies cannot control rising health care costs.
In fact, insurance companies benefit from medical inflation. They just jack up their premiums enough to cover the additional cost and guarantee them a tidy profit.”
The video points out the real drivers of cost growth — from UnitedHealth’s nearly 2,700 acquisitions to Medicare Advantage overpayments that funnel billions from taxpayers into corporate profits.
If you haven’t watched it yet, I hope you will and share it with everybody else you know. It’s clear that Congress must pass common sense guardrails to stop Big Insurance from writing the rules of American health care and squeezing Americans.
The Trump administration is expected to spell out its intentions for Medicare Advantage soon — a program that enrolls about half of U.S. seniors but has drawn intensifying criticism for costing the government too much.
Why it matters:
Centers for Medicare and Medicaid Services chief Mehmet Oz called the system “upside down” during his confirmation hearings, hinting at possible changes to the way the federal government pays and regulates plans.
Any big changes would be a departure from a history of friendly treatment from Republican administrations.
Those could become apparent in the proposed 2027 Medicare Advantage rule, which may come out before the end of this year.
How it works:
Many privately run Medicare plans charge no monthly premium and provide supplemental benefits that traditional Medicare doesn’t cover,like dental coverage and help paying for over-the-counter drugs.
The program was created on the premise that private insurers could manage care better and at a lower price point than the federal government.
But some insurers have since drawn fire for categorizing patients as sicker than they are to get higher payments, and for overly complicated pretreatment reviews.
Advisors to Congress projected the federal government would spend about $84 billion more on Medicare Advantage enrollees this year than for people in traditional Medicare. (Insurers say the advisors’ methodology is flawed.)
Oz has a history of promoting Medicare Advantage plans on his popular television show and advocating for an “MA for All” policy.
But he’s been more openly skeptical since joining the administration, as a growing cadre of GOP policymakers ask questions about the program’s finances and insurers’ role in driving up costs.
“I came both to celebrate what you’re trying to do, but also be honest about some of the issues that we’re seeing at CMS,” Oz said at the industry lobby’s conference last month.
Oz believes choice and competition are needed for a strong Medicare program, but also that CMS has a responsibility to keep “program payments fair, transparent, and grounded in data,” Catherine Howden, the agency’s director of media relations, told Axios in response to a request for comment.
This is an opportunity for Medicare Advantage insurers to have some strategic conversations with CMS about Oz’s vision for the program, said Daniel Fellenbaum, senior director at Penta Group.
UnitedHealthcare, Humana and Aetna are the three biggest Medicare Advantage insurers and cover more than 20 million seniors combined.
Where it stands:
This year CMS announced what it termed an “aggressive” strategy to increase audits of the diagnoses Medicare Advantage plans document for enrollees, which could claw back money from insurers.
Medicare’s Innovation Center said it’s working on pilot programs that could change the way thegovernment pays the plans.
Industry onlookers are also expecting the administration to propose changes to the star ratings system, which measures Medicare Advantage plan quality and dictates bonus payments to plans.
What they’re saying:
Insurers and advocates of private Medicare plans remain optimistic that Oz has their best interests at heart.
“He seems to stress good oversight and holding the program to high standards without losing sight of what’s working for seniors,” said Susan Reilly, vice president of communications at Better Medicare Alliance.
Insurance trade group AHIP welcomes “constructive, data-driven conversations with policymakers on actions that strengthen Medicare Advantage,” CEO Mike Tuffin said in a statement to Axios.
AHIP wants a focus on stability in the program after several years of medical costs increasing faster than Medicare Advantage payment, it said.
Reality check:
The 2026 update to plan payment, the first of this administration, is better than anticipated for insurers, giving them more than $25 billion increase in federal payments.
The Trump administration also struck voluntary agreements with insurers to simplify the rules for authorizing procedures and treatments ahead of time, rather than using its regulatory authority to require changes.
“We hear rhetoric talking tough on MA, but we’ve not seen them put that into actual reality,” said Chris Meekins, managing director at Raymond James.
Any big policy changes next year would also become apparent to seniors right before the midterm elections. Bigger policy swings from the administration might be more likely to go into effect for 2028, Meekins said.
What we’re watching:
President Trump has been vocal about his distaste for health insurance companies on social media lately as Congress debates extending enhanced premium subsidies for Obamacare coverage.
That ire could seep into how he directs his administration to regulate Medicare Advantage.
The Trump administration is expected to spell out its intentions for Medicare Advantage soon — a program that enrolls about half of U.S. seniors but has drawn intensifying criticism for costing the government too much.
Why it matters:
Centers for Medicare and Medicaid Services chief Mehmet Oz called the system “upside down” during his confirmation hearings, hinting at possible changes to the way the federal government pays and regulates plans.
Any big changes would be a departure from a history of friendly treatment from Republican administrations.
Those could become apparent in the proposed 2027 Medicare Advantage rule, which may come out before the end of this year.
How it works:
Many privately run Medicare plans charge no monthly premium and provide supplemental benefits that traditional Medicare doesn’t cover,like dental coverage and help paying for over-the-counter drugs.
The program was created on the premise that private insurers could manage care better and at a lower price point than the federal government.
But some insurers have since drawn fire for categorizing patients as sicker than they are to get higher payments, and for overly complicated pretreatment reviews.
Advisors to Congress projected the federal government would spend about $84 billion more on Medicare Advantage enrollees this year than for people in traditional Medicare. (Insurers say the advisors’ methodology is flawed.)
Oz has a history of promoting Medicare Advantage plans on his popular television show and advocating for an “MA for All” policy.
But he’s been more openly skeptical since joining the administration, as a growing cadre of GOP policymakers ask questions about the program’s finances and insurers’ role in driving up costs.
“I came both to celebrate what you’re trying to do, but also be honest about some of the issues that we’re seeing at CMS,” Oz said at the industry lobby’s conference last month.
Oz believes choice and competition are needed for a strong Medicare program, but also that CMS has a responsibility to keep “program payments fair, transparent, and grounded in data,” Catherine Howden, the agency’s director of media relations, told Axios in response to a request for comment.
This is an opportunity for Medicare Advantage insurers to have some strategic conversations with CMS about Oz’s vision for the program, said Daniel Fellenbaum, senior director at Penta Group.
UnitedHealthcare, Humana and Aetna are the three biggest Medicare Advantage insurers and cover more than 20 million seniors combined.
Where it stands:
This year CMS announced what it termed an “aggressive” strategy to increase audits of the diagnoses Medicare Advantage plans document for enrollees, which could claw back money from insurers.
Medicare’s Innovation Center said it’s working on pilot programs that could change the way thegovernment pays the plans.
Industry onlookers are also expecting the administration to propose changes to the star ratings system, which measures Medicare Advantage plan quality and dictates bonus payments to plans.
What they’re saying:
Insurers and advocates of private Medicare plans remain optimistic that Oz has their best interests at heart.
“He seems to stress good oversight and holding the program to high standards without losing sight of what’s working for seniors,” said Susan Reilly, vice president of communications at Better Medicare Alliance.
Insurance trade group AHIP welcomes “constructive, data-driven conversations with policymakers on actions that strengthen Medicare Advantage,” CEO Mike Tuffin said in a statement to Axios.
AHIP wants a focus on stability in the program after several years of medical costs increasing faster than Medicare Advantage payment, it said.
Reality check:
The 2026 update to plan payment, the first of this administration, is better than anticipated for insurers, giving them more than $25 billion increase in federal payments.
The Trump administration also struck voluntary agreements with insurers to simplify the rules for authorizing procedures and treatments ahead of time, rather than using its regulatory authority to require changes.
“We hear rhetoric talking tough on MA, but we’ve not seen them put that into actual reality,” said Chris Meekins, managing director at Raymond James.
Any big policy changes next year would also become apparent to seniors right before the midterm elections. Bigger policy swings from the administration might be more likely to go into effect for 2028, Meekins said.
What we’re watching:
President Trump has been vocal about his distaste for health insurance companies on social media lately as Congress debates extending enhanced premium subsidies for Obamacare coverage.
That ire could seep into how he directs his administration to regulate Medicare Advantage.
Wall Street reacts to the failed ACA subsidy extension — and to the president’s swipe at “money sucking insurance companies.”
Wall Street got the jitters yesterday after Donald Trump’s pointed remarks about “money sucking insurance companies” and a Congressional deal that failed to extend the enhanced subsidies under the Affordable Care Act (ACA) marketplace plans. According to one market analysis, shares of Centene (CNC) plunged about 8.15% in pre-opening trade, while competitors such as Molina (MOH) fell 4.6%, Elevance (ELV) dropped 3.7%, UnitedHealth Group (UNH) slipped 1.9% and Humana (HUM) declined 1.45%.
Why the sell-off? Because the enhanced ACA subsidies — which reduce premiums for some marketplace enrollees — expire at the end of the year and without renewal, an estimated 3.8 million people could lose coverage, and premiums would rise significantly for others. Insurers that rely on the stability and growing enrollee base of the ACA marketplace face heightened risk when that funding is in question – especially when the dollars are guaranteed – like when they are shoveled out from the federal government.
Still, it’s worth noting that the ACA marketplace business is not the primary profit engine for most large payers. Their bigger gains typically come from taxpayer-funded programs like Medicare Advantage, Medicaid managed-care contracts and veterans’ / VA contracts.
Here’s how five of the major players fared in 2024 profits:
Centene: $3.2 billion (+590% since 2014)
UnitedHealth Group: $32.2 billion (+214% since 2014)
Elevance: $9.1 billion (+78% since 2014)
Humana: $2.6 billion (+8.3% since 2014)
Molina: $1.18 billion (+780% since 2014)
Because most of their gains have not come from ACA exchange plans (and especially not the thin margin employer market) but through their other government-subsidized businesses, investors can have some certainty their investments in those companies are still largely safe and Big Insurance will be able to weather this storm.
For instance, the industry has always been able to strongarm rough patches in the consumer market – as long as they can stave off any meaningful changes to their bread and butter taxpayer-funded programs. As we reported last month, the industry’s outside PR and lobbying friends – Better Medicare Alliance and Medicare Advantage Majority – have hit the airwaves and the halls of Congress to halt the advancement of the No UPCODE Act. The bipartisan bill, sponsored by Senators Bill Cassidy (R-LA) and Jeff Merkley (D-OR) would end wasteful, fraudulent practices in Big Insurance’s Medicare Advantage businesses that funnel taxpayer money into the pockets of industry executives and Wall Street shareholders and could save taxpayers as much as $124 billion over the next decade and keep the Medicare Trust Fund solvent for years longer.
As of this morning, insurers seem to be fairing better. Centene, UnitedHealth Group, Elevance, Humana and Molina are all back in the green.
As open enrollment begins and Congress remains deadlocked on whether to extend the ACA’s enhanced premium subsidies, one question looms large: Where does all the money we pay for health coverage actually go?
It’s a fair question. Premiums and out-of-pocket costs have risen relentlessly over the past decade. Since the Affordable Care Act was fully implemented, the average premium for an ACA marketplace plan has doubled, and the average deductible for a Silver plan has increased by 92%. Every year, families pay more, yet the coverage often feels thinner.
What the Insurers Say
Health insurance companies routinely claim these increases simply reflect rising medical costs and higher utilization. For example, when justifying rate hikes in 2024, Cigna of Texas wrote:
“The increasing cost of medical and pharmacy services and supplies accounts for a sizable portion of the premium rate increases.”
But the financial filings of these same companies tell a different story.
What the Numbers Show
As Wendell Potter recently wrote, from 2014 to 2024 the seven largest publicly traded health insurance companies, UnitedHealth Group, CVS/Aetna, Cigna, Elevance (formerly Anthem), Humana, Centene, and Molina, reported that they collectively made more than half a trillion dollars in profits.
That’s money collected from individuals, employers and taxpayers for health coverage — dollars that didn’t go to medical care but instead flowed to corporate shareholders and executive bonuses. To put this in perspective, those profits alone could fund the enhanced ACA premium subsidies for another ten years, at an estimated cost of $350 billion.
Over the same period, these seven companies spent $146 billion buying back their own stock or, in other words, using premium dollars from patients and employers to boost share prices and executive compensation (the CEOs and many other top executives of big insurers are compensated primarily through stock grants and options).
Stock buybacks don’t lower premiums, expand networks, or improve care. They simply make investors and executives richer. If that same money had been reinvested in enrollees, it could have provided premium-free health coverage to more than 5 million families for an entire year, based on the average employer-sponsored plan cost of $27,000 in 2026.
Lobbying With Our Premium Dollars
Insurers aren’t just rewarding shareholders, they’re also shaping the political system that protects their profits. Since 2014, the seven largest insurers and their trade association, AHIP, have spent $618 million on lobbying.
That’s money that could have been used to lower out-of-pocket costs or improve patient care, but instead it’s spent to influence Congress and federal agencies to maintain the status quo.
The Real Problem — and the Real Solution
As the cost of health insurance continues to climb, politicians debate how to control those costs and expand coverage. But the truth is, there’s already enough money in the system to cover everyone. It’s just being siphoned off by insurance corporations for profits, lobbying, and stock buybacks.
Though some have been calling for less regulation of Big Insurance, that is not the answer and is partly how we ended up in this situation. Right now, Big Insurance is allowed to use premium dollars and tax dollars on things that do nothing to improve anyone’s health – such as stock buybacks and lobbying – instead of on medical care.
Rather than asking families and taxpayers to pay more, it’s time to demand accountability from insurers. At a minimum, they should not be allowed to use premium dollars, or taxpayer dollars, to enrich shareholders through stock buybacks (which wasn’t even legal until the 1980s) or lobby for policies that drive up costs.
If we want to contain health care costs, the first step is simple: Stop the profiteering by Big Insurance.
For four years, people buying health care on the Affordable Care Act (ACA) marketplace have benefited from government subsidies that made their plans more inexpensive, and thus more accessible.
Now, those subsidies have become a key point of contention between Democrats and Republicans in a government shutdown that went into effect on Oct. 1 after both sides failed to reach a deal.
Democrats want Congress to extend the enhanced premium tax credits first added in 2021; without an extension, the tax credits expire at the end of 2025 and experts say premium prices could double in 2026.
“They know they’re screwed if this debate turns into one about healthcare. And guess what? That’s just what we’re doing. We are making this debate a debate on healthcare,” said U.S. Senator Chuck Schumer, a Democrat from New York, hours before the government shut down.
Republicans say that Democrats want to extend free health care for unauthorized immigrants, a talking point that is not true but that has nevertheless been repeated many times by GOP politicians. (Democrats want to reverse health policy changes that the GOP’s tax law enacted, including limits to federal funding for health care for “lawfully present” immigrants.)
Neither side appears ready to budge, which means that as of right now, people who buy health care on the Affordable Care Act (ACA) marketplace are about to be in for some sticker shock. Monthly out-of-pocketcosts are set to jump as much as 75% for 2026 because of the disappearance of federal subsidies and higher rates from insurers.
“Most enrollees are going to be facing a double whammy of both higher insurance bills and losing the subsidies that lower much of the cost,” says Matt McGough, a policy analyst at KFF for the Program on the ACA and the Peterson-KFF Health System Tracker.
KFF recently calculated that the median rate increase proposed by insurers is 18%, more than double last year’s 7% median proposed increase. But the actual blow to patients is going to be much higher. That’s because enhancements to premium tax credits are set to expire at the end of 2025.
Around 93% of marketplace enrollees—19.3 million people—received the enhanced premium tax credits, according to the Center on Budget and Policy Priorities, saving them $700 yearly on average. For some people, the tax credits meant that they wouldn’t have to pay an insurance premium if they chose certain plans. For others, it meant getting hundreds of dollars off a health plan they otherwise wouldn’t have been able to afford.
Premium tax credits helped people afford plans on the Affordable Care Act marketplaces between 2014 and 2021. Then, in 2021, enhancements to those premium tax credits went into effect with the American Rescue Plan. Before 2021, premium tax credits were only available to people making between 100-400% of the federal poverty limit—so between $25,8200 and $103,280 for a family of three in 2025. The enhanced tax credits were expanded to households with incomes over 400% of the federal poverty limit, and were also made more generous for everyone. That wide range meant they subsidized coverage for people who otherwise would not have gotten any break on their premiums.
The enhancements to the premium tax credits, which are set to expire at the end of 2025, significantly boosted enrollment in Affordable Care Act marketplace plans. More than 20 million people enrolled in marketplace coverage in 2024, according to the Center on Budget and Policy Priorities, up from 11.2 million in February 2021, before the enhancements to the tax credits.
With costs being lowered by half, individuals and families decided, ‘OK, maybe this is financially worthwhile,’” says McGough. “Whereas previously, they thought that they didn’t utilize that much health care, so it wasn’t worth it to purchase health care on the marketplaces.”
Why insurers want to increase rates
Every year, health insurers submit filings to state regulators that detail how much they need to change rates for their ACA-regulated health plans. KFF analyzed 312 insurers across 50 states and the District of Columbia; they found that insurers are requesting the largest rate changes since 2018.
They are requesting the median 18% increase for a few reasons, including rising health care costs, tariffs, and the expiration of the premium tax credit enhancements, KFF found. Health care costs have been rising for years, but insurers say that the cost of medical care is up about 8% from last year. They say that tariffs may put upward pressure on the costs of pharmaceuticals and that growing demand for GLP-1 drugs such as Ozempic and Wegovy is driving up their expenses.
Worker shortages are also driving health care costs up, according to the KFF analysis. It also found that consolidation among health care providers was leading to higher prices because those providers had more market power.
Everyone’s bottom line could be affected
When they went into effect, the enhanced premium tax credits pushed some people into the marketplace who might otherwise have been uncertain about whether to get health insurance. The tax credits were graduated so that people with the lowest incomes got the most help, but they also reached people with slightly higher incomes.
Many people don’t know that those enhancements to the premium tax credits are going away, says Jennifer Sullivan, director of health coverage access for the Center on Budget and Policy Priorities (CBPP). Her organization has been talking to people across the country about how they may be affected if Congress does not extend the enhancements, and has found that even increases of $100 or $200 a month may be enough to force some people out of the marketplace.
“It’s a huge increase in anyone’s budget, particularly at a time when groceries are up and the cost of housing is up and so is everything else,” Sullivan says.
There are other reasons the ACA marketplace may see fewer enrollees, she says. A handful of policies passed by Congress require more verification to enroll in ACA plans and cut immigrant eligibility, for example.
Fewer enrollees are bad news for everyone else. The people who are likely to drop coverage are those who don’t need it for lifesaving treatment or medicine. That means the pool of people who are still covered by ACA plans will be sicker and more expensive to care for.
“The people who are left are statistically more likely to be people with higher health care needs,” says Sullivan, with CBPP. “Those are the folks that are going to jump through extra hoops, whether it’s more paperwork or higher premiums or higher out-of-pocket costs, because they absolutely know they need the coverage.”
There are other society-wide effects to people dropping their health insurance coverage. Many uninsured people end up in emergency rooms for care because that’s their only option, and sometimes, they can’t pay. That increases the cost of health care for everyone else, says Sullivan.
Amy Bielawski, 60, is one of the people who is going to look at her options when rates for marketplace plans are listed in October and decide whether or not to enroll. Bielawski, an entrepreneur and entertainer who performs belly dancing at parties, has spent much of her life without health care.
She finally signed up for an ACA plan in 2019, and was able to go to a doctor and diagnose her hypothyroidism and uterine fibroids. Last year, because of the enhanced premium tax credits, she paid $0 a month in premiums—which will almost certainly go up.
“I’m afraid, I’m very afraid,” says Bielawski, who lives in Georgia. “I can’t wrap my head around it because there are so many things that can go wrong with my health.”
Where politicians stand now
Addressing this uncertainty is one key reason the Affordable Care Act passed in the first place in 2010. It has dramatically improved health coverage for Americans; nearly 50 million people, or one in seven U.S. residents, have been covered by health insurance plans through ACA marketplaces since they first launched in late 2013.
But it has also faced numerous challenges, and Republicans have long said that weakening or revamping the law is a high priority.
It’s unclear if the hassle of a government shutdown will make them change their tune. In September, Senate Majority Leader John Thune, a Republican from South Dakota, said he was open to addressing the expiration of the subsidies, but that he did not want to tie any of those policy changes to government funding measures. Sen. Mike Rounds, also a Republican of South Dakota, has suggested a one-year extension to the subsidies, after which the tax credits return to pre-pandemic levels.
Many Republicans appear determined to end the subsidies eventually, and their insistence on scaling back spending on health care policy seems to be having an impact.
Sullivan, with the CBPP, says that the changes to the Affordable Care Act and looming cuts to Medicaid have the potential to dramatically reduce the number of people able to afford regular medical care in the country. These cuts come at a time when key indicators like infant mortality rates and life expectancy rates are worsening.
“We are seeing a real weakening of that safety net that we spent the last 10-15 years fortifying,” she says.
HENRY KOTULA 