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.
In what political pundits called a sweeping win by Democrats in Tuesday’s elections, affordability and costs of living emerged as the issues that mattered most to voters. It’s no surprise.
Since 2019 before the pandemic, prices have increased for American businesses and households due to inflation:
Personal Consumption Expenditures (PCE) inflation which measures monthly business spending increased 3.5% annually. The Consumer Price Index (CPI), which measures monthly changes in household spending increased 3.87% annually over the same period (2019-2025).
But in the same period, prices for healthcare services–hospitals, physician services, insurance premiums and long-term care–have taken an odd turn: for businesses, they’ve decreased but for consumers, they increased.
It reflects the success whereby businesses have shifted health benefits costs to employees or suspended benefits altogether, and it explains why consumers are bearing more direct responsibility for healthcare costs and are increasingly price sensitive.
A proper interpretation of PCE and CPI data points to a bigger problem: household exposure to increased prices hits younger, middle-income households hardest because their housing costs consume 36-60% of their disposable income. Food costs are an additional 13-20%. That doesn’t leave much room for healthcare when child care, student debt and transportation costs are factored.
Increased attention to household affordability and costs of living is uncomfortable in the healthcare industry. The good news is that expenses for health services represents a small fraction of spending; the bad news is those expenses are increasing along with competing categories and they’re sometimes unpredictable.
The fundamental operating model in healthcare is ‘Business to Business/B2B’ transactions between producers (physicians, hospitals, drug and device makers), middlemen (insurers, PBMs, employers) and users (consumers) reinforced by state and federal regulation that protect the status quo. And ‘users’ are treated as patients or enrollees, not a market that makes buying decisions based on value and costs. Thus, lack of price transparency in healthcare coupled with lack of predictability when services are used lends to public confusion or, in extreme cases, contempt. The public reaction to the murder of UnitedHealth Executive Brian Thompson last year surfaced the public’s latent animosity toward healthcare’s business practices that treat consumers as pawns on a complicated chessboard.
Shifting direct financial responsibility to consumers is the blunt instrument touted by economists who rightly argue informed decision-making by consumers is necessary to lower costs and improved value from the system. It won’t happen overnight if at all, and the system’s affordability in working age households will be the impetus.
The near-term implications are clear:
Increased household discretionary spending for necessities (food, transportation, and housing) will shrink discretionary spending for healthcare products and services:
Consumers believe their basic needs—food, shelter, transportation–are easier to predict and manage than their out-of-pocket bills for insurance premiums, co-pays, deductibles, over-the-counter products and more. 60% are financially insecure, and unanticipated medical costs is their biggest concern.
Consumers think the healthcare system is ‘dominated by ‘Big Business’ that prioritizes profit before everything else. The majority of consumers in every age, income, education, ethnic and partisan affiliated cohort share this view and are dissatisfied. Elected officials in both parties believe consolidation in health services has increased prices and reduced competition for consumers. The frontline healthcare workforce is demoralized by its corporatization and resentful of leaders they consider overpaid and accountable for financial results only.
Consumers (voters) will support policy changes to the health system that increase its accountability for affordability.
Among providers, momentum for price controls, price transparency, executive compensation limits, justification for tax exemptions, revenue cycle management practices, will be strong especially in state legislatures.
Among insurers, claims data accessibility, standardization & justification of coverage, denials, prior auth and network adequacy, premium pricing, administrative cost accountability, executive compensation, will be foci of regulation.
Among suppliers to the health services industry—drug companies, device makers, information technology solution providers, consultants and professional services advisors, supply chain middlemen et al—disclosure of business relationships and transparency re: direct and indirect costs will be mandated.
Final thought:
Throughout my career, ‘patient centeredness” has been the fundamental presumption on which service delivery by providers has been justified. Affordability has been neglected though increasingly acknowledged in rhetoric. Executives in healthcare services are not compensated for setting household affordability targets and publicly reporting results. Most compensation committees and Boards have marginal understanding of household economics in their communities and depend on “revenue cycle management” to address consumer payment obligations at arms-length. Even the medical community is not immune: one in 5 medical students is food insecure, 4 of 5 medical residents is financially insecure, and their career choices are increasingly dependent on their earning potential. So, calls for greater attention to affordability in healthcare will originate from insiders and outsiders tired of excuses and lip service.
Insecurity about household finances is significant and growing. Per the University of Michigan Index of Consumer Sentiment (50.3 in November 2025) is near an all-time low. It’s reality in the majority of U.S. households. The federal shutdown, discontinuance of SNAP benefits, cuts to ACA subsidies for insurance, corporate layoffs and higher costs for child care, groceries, gas and housing are a tsunami to American households.
Last week, voters elected: Zohran Mamdani, 34 (NYC); Abigail Spanberger, 46 (VA); and Mikie Sherrill, 53 (NJ) in races touted as a weather-vane for elections in 2026 and beyond. It is bigger than partisan elections. Voters in both parties and across the country are worried about affordability. It’s especially true among younger generations who worry about making ends meet and think institutions like the political system, higher education, organized religion and healthcare are outdated.
Healthcare service providers can ill afford to neglect affordability. It more than measuring medical debt, posting prices and referencing concern on websites. It’s about earning the trust and confidence of future generations through concrete actions that increase household financial security beginning with healthcare spending.
Paul
PS As never before, the voices of younger generations are being heard across the country though social media and demonstrations. The health system is among their major concerns as they ponder how they’ll be able to pay for their bills While Medicare seems the focus to policymakers and beltway pundits who rightly recognize seniors as its most costly population, the working age population has been taken for granted. Here’s a voice I follow closely. Fresh Perspective Is Sometimes Needed – by K. Pow
The U.S. health system’s future is uncertain but outside forces will define its direction.
9 structural changes appear necessary to a transformed system of health that’s affordable, comprehensive and effective.
Last week, I had a 27-hour stay in a hospital emergency room waiting for an open bed and a morning at the food pantry loading boxes in anticipation of a possible SNAP program suspension surge. It wasn’t the week I expected. So much for plans!
Such is the case for health insurance coverage for millions in the U.S. as the federal government shutdown enters Week 6. Democrats are holding out for continuation of Affordable Care Act (ACA) insurance subsidies that enable 22 million to “buy” insurance cheaper, and Republicans are holding out for federal spending cuts reflected in the One Big Beautiful Act (July 2025) that included almost a trillion reduction in Medicaid appropriations thru 2036.
ACA subsidies at the heart of the shutdown successfully expanded coverage in tandem with Medicaid expansion but added to its costs and set in motion corporatization and consolidation in every sector of the health system. The pandemic exposed the structural divide between public health programs and local health systems, and insurance premium increases and prior authorization protocols precipitated hostility toward insurers and blame games between hospitals, insurers and drug companies for perpetual cost increases.
Having mediated discussions between the White House and industry trade groups as part of the ACA’s design (2009), I witnessed first hand the process of its development into law, the underlying assumptions on which it is based and the politics before and after its passage in March 2010. Its hanging chads were obvious. Its implementation stalled. Its potential to lower costs and improve quality never realized. It was a Plan disabled by special interests that rightly exploited its flaws and political brinksmanship that divided the country. But more fundamentally, it has failed to lower costs and improve affordability because it failed to integrate outside considerations—private capital, employers, technologies, clinical innovations and consumer finances—in its calculus.
Sixteen years later, healthcare is once again the eye of the economic storm. Insiders blame inconsistent regulatory enforcement and lack of adequate funding as root causes. Outsiders blame lack of cost controls. consolidation and disregard for affordability. Thus, while attention to subsidized insurance coverage and SNAP benefits might temporarily calm public waters, they’re not the solution.
All parties and all sides seem to agree the health system broken. For example, in my trustee surveys before planning sessions with Boards of health systems, medical groups and insurers, the finding is clear:
92% says the future of the U.S. health system in 7-10 years is fundamentally changed and not repeat of its past.
84% say their organizations are not prepared because short-term issues limit their ability to long-term planning.
Republicans think market forces will fix it. Democrats think federal policy will fix it. The public thinks it’s become Big Business that puts its interests before theirs. And the industry’s trade groups—AMA, AHA, AHIP, PhRMA, Adame, APHA, et al—face intense pressure from members adversely impacted by unwanted regulatory policies.
Few enjoy the luxury of long-term planning. That doesn’t excuse the need to address it. If a clear path to the system’s future is not built, incrementalism will enable its inevitable insolvency and forced re-construction.
What’s the solution? When comparing the U.S. health system to high performing systems in other high-income countries, these findings jump out:
All spend less on healthcare services and more on social services than the U.S.
All include government and privately-owned operators
All fund their systems primarily through a combination of federal appropriations and private payments by employers and citizens.
All pursue clinical standardization based on evidence.
All are dealing with funding constraints as their governments address competing priorities.
All are transitioning from episodic to chronic health as their populations age and healthiness erodes.
All are focused on workforce modernization and technologic innovations to lower costs and reduce demand for specialty services.
All enable private investment in their systems to increase competition and stimulate innovation.
All facilitate local/regional regulatory oversight to address distinctions in demand and resources.
All face with growing public dissatisfaction.
All are expensive to operate.
No system is perfect. None offers a copy-paste solution for U.S. taxpayers. And even if one seemed dramatically better, it would be a generational surge rooted in futility that welcome it.
What’s the answer? At the risk of oversimplicity, the future seems most likely built on these 9 structural changes:
Integrate social services (public health) with delivery.
Create comprehensive primary and preventive health gatekeeping inclusive of physical and behavioral health, nutrition, prophylactic dentistry and consumer education.
Rationalize specialty services and therapies to high value providers.
Incentivize responsible health behaviors across the entire population.
Increase private capital investments in healthcare.
Modernize the workforce.
Fund the system strategically.
Define and disclose affordability, quality and value systemically.
Facilitate technology-enabled self-care.
This will not happen quickly nor result from current momentum: the inertia of the status quo leans substantially toward protectionism not because it’s unaware. The risks are high. And while the majority of Americans are frustrated by its performance, there’s no referent to which look as a better mousetrap.
I anticipated last week would be pretty uneventful. It wasn’t. My Plan didn’t work out due, in part, to circumstances I didn’t foresee or control.
Healthcare’s the same. Outside forces seen or not will impact its future dramatically. Plans have to be made though Black Swans like the pandemic are inevitable. But long-term planning built on plausible bets are necessary to every healthcare organization’s future.
America’s health care system is neither healthy, caring, nor a system.
– Walter Cronkite
Healthcare policy in America is too short-sighted and vulnerable to party-politics. We need a system that’s built to last.
As open enrollment through the ACA marketplace begins November 1, millions of Americans will soon discover their health insurance rates going up in 2026 as the direct result of ACA tax subsidies expiring because party politicians in charge of the Senate refuse to budge. If you know how much your rates will be increasing in 2026, please share so I can see the impact that this inaction will have on regular folks.
Career politicians like my opponent Mike Rounds aren’t willing to stray from the party line to make sure Americans and their families get affordable healthcare, and in the process they are causing innumerable harm to not just those Americans on ACA, but also all the furloughed federal employees and families on SNAP. Something needs to change.
As an Independent candidate who supports pragmatic solutions, I will not claim my proposals are the best or only choices, but I will claim just about anything will be overall less expensive and more effective than the status quo. The bottom line is that our dysfunctional politics have us fighting over half-measure solutions to today’s problems instead of complete solutions to tomorrow’s.
Overhauling American healthcare is a complex challenge, but that cannot let it deter us. Americans deserve access to affordable, quality care. According to a KFF analysis, healthcare accounted for 27% of federal spending in fiscal year 2024. The U.S. spends far more per person on healthcare than any of the other 37 members of the Organization for Economic Co-operation and Development (OECD). Despite spending nearly twice as much per person as similar wealthy countries, we still rank poorly on key health outcomes.
America does, however, hold a commanding lead in medical debt, accounting for between 50% and 66% of annual personal bankruptcies. Other wealthy countries clearly understand better how to set up a healthcare system that is both less expensive and produces the same or better outcomes.
Considering the immense costs and mediocre outcomes, I am reminded of the famous observation from Dr. Amos Wilson: “If you want to understand any problem in America, you need to look at who profits from that problem, not at who suffers from that problem.” Having done so, I support an incremental reinvention of the American healthcare system that doesn’t just solve immediate problems such as premium hikes, expiring ACA subsidies, or Medicare cuts, but also secures a stable and healthy future for the American people.
My plan for America’s healthcare system has three basic steps, ensuring folks can get the care they need, now and in the future.
Stage 1: Fixing the Supply Side: Regulate Healthcare Companies, Lower Drug Prices, & Encourage Preventive Care
The healthcare industry (from insurers to providers) is a functional monopoly, especially at the local/regional level, similar to electric, gas, and telecommunications companies. It deserves to be treated the same way. Drawing from how the South Dakota Public Utilities Commission (and similar entities in other states) regulate utility companies to ensure that they provide “reliable service” and “reasonable rates,” creating a regulatory framework for healthcare companies (including insurers) is a good first step in adapting our current system into one that considers the needs of regular folks. Providers shouldn’t have to butt heads with insurers to provide the services that patients need, so creating a more transparent and regulated system would benefit every level of the process.
Pharmaceutical companies have the highest profit margins in the healthcare industry. According to a RAND report, Americans pay 278% higher prescription drug prices than similar countries where the government negotiates drug pricing. The common-sense solution is for the federal government to negotiate pricing for all drugs. Doing so will yield much greater savings for both the government and consumers.
To offset reduced pharmaceutical company profits and also help more consumers, the U.S. should negotiate a treaty with the European Union and other G7 countries to establish a pharmaceutical common market based on uniform drug development/approval standards enabling the elimination of trade barriers for drugs.
RFK Jr.’s “Make America Healthy Again” (MAHA) agenda includes multiple nonsensical proposals that are likely to do the opposite, but there are a handful of beneficial ideas. A MAHA focus on preventive care that strengthens primary care, expands access to screenings, and incentivizes healthy lifestyles will lower long-term healthcare spending the same way that keeping up routine maintenance on your car prevents big repair bills in the future.
Investing in community health centers, mobile clinics, and telehealth services will make preventive care more accessible, particularly in underserved rural and urban areas. Similarly, reducing reliance on highly processed foods and ensuring government nutrition assistance programs incentivize and enable healthy foods would also pay dividends.
Many states approve the rates that insurers charge consumers, but these rates increase as the base cost of providing healthcare services increases. Holding healthcare companies, providers and insurers alike, to uniform standards and making information transparently available for comparison will remove the various pressures driving up the cost of care, keeping rates down for consumers.
Stage 2: Fixing the Demand Side: Create a Public Option, Streamline Administration, Increase Residency Slots
Profits are up 230% for the top 5 health insurance companies since the Affordable Care Act (ACA) was adopted, while family premiums have also skyrocketed. While I think it was a step in the right direction to provide folks with healthcare, it isn’t a viable permanent solution. Creating a broadly available public option would enable Americans to buy into a health insurance plan administered by the government.
A public option like this wouldn’t have a profit motive, so it would be able to offer lower-cost plans, creating a baseline for other companies to compete with. Increased competition would drive down premiums and improve quality of service across the market, even amongst private for-profit insurers.
Technology can also help lower costs by reducing the complicated bureaucracy healthcare administrators must navigate. Healthcare providers currently spend enormous time and money dealing with insurance paperwork, eligibility verification, and billing disputes. Universally interoperable electronic health records (EHRs) and streamlined billing systems would significantly reduce costs. Uniform standards for these processes and better technology infrastructure would free up providers’ time to focus more on patient care.
By 2036, the U.S. is projected to need 86,000 more physicians than it will have. The primary cause of the growing shortage is a 1997 law freezing federal support for Medicare-funded residency positions. Limiting the number of doctors in training also fosters misallocation of training slots across the country, creating a mismatch between where they train and where they are needed most. Correcting this self-inflicted shortage is essential to maximizing access.
On the subject of innovative approaches to providing healthcare, fee-for-service payment models reward volume over value, encouraging unnecessary tests and procedures. Transitioning to value-based care, where providers are paid based on patient outcomes, can lead to better health outcomes at a lower cost. Accountable Care Organizations (ACOs), bundled payments, and capitation models (in which providers receive a fixed fee per patient for a specific time period regardless of services delivered) have shown promise in reducing spending while maintaining or improving quality.
Stage 3: Use The Foundation To Build a Better System
While I believe that our leaders today should be looking towards the future with long-lasting solutions rather than scrambling for band-aid policies, I also know that we shouldn’t put the cart before the horse. I believe that Stages 1 and 2 lay the foundation for a healthier America and a more streamlined healthcare system. Stage 3 of my plan is geared towards keeping our options open for the future of American healthcare.
All OECD countries with lower per-person healthcare spending provide universal or near-universal coverage to their citizens. Various universal healthcare systems seem to be an effective way to improve access and reduce systemic costs. In particular, I think that looking to our allies such as Canada (with a single-payer system) and Germany (with a multi-payer system) would be a good place to start. In both systems, the government negotiates prices directly with providers and pharmaceutical companies, leading to significant cost savings for consumers.
Conclusion
In summary, the American healthcare system doesn’t suffer from a lack of resources but rather anti-competitive profit-seeking, inefficiency, and a lack of imagination. Creative solutions lie in addressing the supply and demand side of the healthcare industry, continuously blending technological innovation, community-based delivery, and incentivizing healthier living.
No single policy will fix the U.S. healthcare system overnight, but a combination of reforms can dramatically improve access and lower costs. Providing a public option is a foundational step that keeps options open for other innovations. In tandem, reforms such as drug price negotiation, investment in preventive care, value-based payments, and administrative simplification can deliver a more efficient and equitable healthcare system. Political will and public support are crucial, but the long-term benefits for individuals, businesses, and the broader economy make these changes not only possible but necessary.
The path forward is not and cannot be a purely partisan choice of public versus private. It must be guided solely by a simple question: What is most effective at making healthcare cheaper, faster, and more accessible for everyone? At this point, I believe a robust public option is essential, but I remain unsure whether a single-payer or a refined version of a multi-payer universal system is warranted. I’m keeping an open mind.
I am sure that Washington politicians shouldn’t be screwing over regular Americans by making their healthcare inaccessible or more expensive. As South Dakota’s Independent senator, I would be empowered to break through party-first politics to make sure people always come first.
The American healthcare is complicated, so this article leans on the longer side to try and do it justice. Thank you for reading.
After a long career as a nurse, Lisa Bower, now 61, retired, started working as a part-time nanny, and, in 2021, realized she needed health insurance. The Illinois resident took to the Internet to sign up for a plan on the Affordable Care Act (ACA) marketplace.
But something went wrong and she somehow ended up on another website that looked a lot like a health insurance marketplace. She entered her phone number and soon started getting calls and texts from people who wanted to help her get health insurance.
Within a few minutes, she was registered for a plan that she thought was ACA-compliant. But Bower had instead signed up for what’s called a fixed indemnity plan, which is not actually health insurance and which just pays a small amount for covered services. She didn’t realize that she didn’t have proper health insurance until the fall of 2025, when her son was looking for a tax form that proved she had marketplace insurance and, unable to find it, started digging into her health care paperwork.
Over three years, he found, she’d paid about $16,000 to the fixed indemnity company while receiving very little benefit. During this time, she’d paid out of pocket for costs like doctor’s appointments and medications. Had she gotten an ACA-compliant plan, she probably wouldn’t have had to pay much in premiums at all, her son says, because her low income would have qualified her for subsidies.
“I did think at the time that it was less painful to sign up than I thought it would be,” says Bower. “I just chose what I thought was a cheap plan and didn’t think much about it.”
Bower’s son, Jack, says that Illinois’s real health care marketplace found evidence of Lisa starting to sign up in 2021, but says that she did not complete the application. Instead, he guesses, she got lured away by Google ads and ended up somewhere else.
“I think she holds a third of the blame, and another third of the blame goes to this company that knowingly does this marketing to get people to pay for things they don’t actually want,” Jack says. “But the other third of the blame goes to our health care system, which is so complicated that companies just thrive in the confusion and an astute person can’t make heads or tails of it.”
The Bowers’ experience is not particularly unusual. Confusion about navigating insurance writ large and the Affordable Care Act marketplace in particular has led many people to end up with plans that they think are health insurance which in fact are not health insurance. They mistakenly click away from healthcare.gov, the website where people are supposed to sign up for ACA-compliant plans, and end up on a site with a misleading name that may provide them with an ACA-compliant plan but also might not.
Experts are predicting that this will happen to a larger degree when ACA open enrollment begins in most states on November 1. Because Congress did not extend enhanced premium tax credits, prices for ACA plans are going up an average of 75%. This may spur more people to search for less expensive plans and end up with something that is not health insurance, whether they know it or not.
“There’s no question that more people will end up with these kinds of plans if the premium tax credits are not extended,” says Claire Heyison, senior policy analyst for health insurance and marketplace policy at the Center on Budget and Policy Priorities, a research and policy institute.
Under the Affordable Care Act, health insurance must cover 10 essential benefits, including outpatient services, emergency services, maternity and newborn care, behavioral health treatment, prescription drugs, and pediatric services. But if people stray from the ACA marketplace, they can end up with plans that don’t cover some—or any—of these essential health benefits. People may end up with short-term plans that don’t last for a full year, or with the type of fixed indemnity plan that Bower got. Others may end up in health care sharing ministries, in which people pitch in for other peoples’ medical costs, but which sometimes do not cover preexisting conditions.
These non-insurance products “have increasingly been marketed in ways that make them look similar to health insurance,” Heyison says. To stir further confusion, some even deploy common insurance terms like PPO (preferred provider organization) or co-pay in their terms and conditions. But people will pay a price for using them, Heyison says, because they can charge higher premiums than ACA-compliant plans, deny coverage based on pre-existing conditions, impose annual or lifetime limits on coverage, and exclude benefits like prescription drug coverage or maternity care.
Often, the websites where people end up buying non-ACA compliant insurance have the names and logos of insurers on them. Sometimes, they are lead-generation sites—like the one Lisa Bower mistakenly visited—that ask for a person’s name and phone number and then share that information with brokers who get a commission for signing up people for plans, whether they are health insurance or not.
“This can definitely happen if someone starts Googling and clicks on the first thing they see,” says Louise Norris, health policy analyst at healthinsurance.org, an independent site providing information about insurance plans. “People might not realize that what they’re seeing isn’t real health insurance.”
These mistakes are enabled by a legal gray area in which websites can imply that they can help people sign up for health insurance and then actually sign them up for something else. Brokers, who often work for particular health insurance companies, can often sign people up for both ACA-compliant plans and non-ACA compliant plans. But they typically get more money signing up someone for a non-ACA compliant plan than an ACA-compliant plan, says Heyison.
Non-ACA compliant plans can spend more on administration costs like brokers and marketing because they aren’t regulated in the same way as ACA-compliant plans and have more cash to spare.
Health insurance is complicated, and brokers exist to help walk people through the process of signing up for health insurance. But they sometimes don’t have consumers’ best interest at heart, says Emma Freer, senior policy analyst for the American Economic Liberties Project. “It’s just very predatory because people clearly want information and guidance,” she says, “but many middlemen are incentivized to operate with their own financial interest in mind, not the consumer’s.”
There has been some legal action against companies who have represented what they’re selling as health insurance, even though it’s not. In May 2025, the U.S. Attorney’s Office for the Eastern District of Pennsylvania charged four businessmen and two companies with conspiracy and wire fraud offenses, alleging they had executed a national telemarketing fraud scheme in which they collected tens of millions of dollars by “systematically deceiving and misleading consumers seeking health insurance through bait-and-switch sales tactics.” And in August 2025, two companies agreed to pay a total of $145 million to settle Federal Trade Commission charges that they deceived consumers into purchasing health care plans that did not provide the comprehensive coverage that was promised.
But because many of these companies are actually offering products that are legal—they just aren’t comprehensive health insurance—it can usually be difficult for people to recover any money, or to even get out of the plans. People who discover they signed up for the wrong plan during their state’s open enrollment period should still be able to cancel the plan and sign up for real health insurance, says Heyison, of CBPP. But those who don’t find out for months—or years—that they signed up for non-ACA compliant plans may have a harder time.
“It is definitely a situation where people need to pay close attention now, because in most cases you don’t get a do-over,” says Norris, of healthinsurance.org.
Brandon A., a 27-year-old Maryland resident, didn’t have a lot of experience signing up for health insurance because he’d been in the military and gotten health insurance there. When he went to research plans on the ACA marketplace in mid-October, he searched online for Maryland Health Connection, the state’s marketplace, but ended up on marylandhealthcoverage.org instead.
After entering his zip code and some personal information like his social security number, he got a quote for a plan. He also started getting bombarded with texts and phone calls from people who wanted to sign him up for health insurance. He chose a plan that was just a $300 deposit and $100 a month afterwards. After a few days, and checking with some friends, something seemed off to him, so he called the company back to cancel. They argued with him, telling him it was “the best healthcare nationwide,” he says, but eventually allowed him to cancel the plan.
In retrospect, Brandon, who didn’t want his last name used because he’s embarrassed about his error, saw that in the website’s fine print at the very bottom, in very small text, it says it is not a federal or state health insurance marketplace. “It seems too easy for these sites to pose as real marketplaces,” he says.
Marylandhealthcoverage.org is operated by NextGen Leads, a lead-generation site that collects the information of people looking for health insurance and then charges companies for that information. It has more than 100 complaints on the Better Business Bureau of San Diego, where the company’s website says it is based. Many of the people filing these complaints say that they thought they were signing up for marketplace health insurance in states like Maryland and Georgia, entered their personal information on a site owned by NextGen Leads—often with a domain name ending in .org— and then got spammed with hundreds of calls and texts from people trying to sell them health insurance products. “Their fraudulent website to mimic a health marketplace for [redacted] resulted in selling my information where now I received so many calls from spammers that I literally can not use my phone due to the insane amount of calls,” one person wrote, in January 2025. The company did not reply to TIME’s request for comment.
Experts recommend that people who are stuck in plans that they didn’t mean to buy contact their state insurance commissioner to report the problem. They should also contact a health care navigator or assister—federally funded individuals who exist solely to provide unbiased information—to see if they might qualify to sign up for a comprehensive health insurance plan through a special enrollment period because of a qualifying life event.
Navigators and assisters are also helpful for those seeking new insurance, rather than engaging with brokers. Healthcare.gov is the best place for people to sign up for health insurance who want to do it on their own. Though about 20 states run their own marketplaces that use a different URL, healthcare.gov will direct them to the state marketplaces. It can also direct them to local assisters and navigators.
Signing up for a plan on the true ACA marketplace should not lead consumers to get bombarded with texts or calls—if this happens to you, it probably means you ended up on a lead-generation site instead of on the real marketplace.
Heyison, of CBPP, recommends that consumers never rely on verbal promises that someone selling health insurance gives over the phone, they should instead ask for the plan documents. They should avoid companies offering an upfront gift for signing up, and ones that say that a certain price will only last a few days. Consumers should also spend a few days researching a plan, rather than buying the first thing they see, Heyison says. They should be looking for a plan on healthcare.gov and one that is ACA-compliant.
Some states are attempting to further regulate brokers and non-ACA compliant plans, Heyison says. In California, for instance, agents and brokers are required to assess people for Medicaid and the ACA’s premium tax credit because they enroll them in health care sharing ministries, which could save them money by signing them up for government health insurance instead of a product that is not health insurance. And some states, including California, Illinois, and Massachusetts, prohibit the underwriting of short-term health insurance coverage, making it nearly impossible to sell non-ACA compliant plans in those states.
But most other states haven’t taken action, leaving people like Lisa Bower out of luck. Her son Jack tried to call the company that issued her indemnity plan and get a refund, but he knows he likely has no legal recourse. She should have read the paperwork more closely, they both admit. This year, they’re ready for open enrollment—and are determined not to look anywhere but healthcare.gov, the official Affordable Care Act marketplace.
The cost of hiring help to care for an elderly or a sick person at home is skyrocketing.
Why it matters:
A labor shortage and surging demand from an aging population was already driving up prices, and nowthe White House’s crackdown on immigration and funding cuts are making things worse.
By the numbers:
So far this year, the price of in-home care for the elderly, disabled or convalescent at home is up 10%, compared with a rise of 3% for prices overall, according to government data.
From just August to September, prices for home health care spiked a staggering 7%.
Zoom in:
Rising prices and the limited availability of people who do this work are pushing families to make hard choices. Some will put relatives and loved ones into institutions, a more expensive and often less desirable option than staying at home.
Others will drop out of the workforce or cut back their hours to care for parents, relatives or partners.
The supply of workers is not keeping up with demand, Matthew Nestler, senior economist at KPMG, writes in a post. “That hurts workers and their families, employers and the overall U.S. economy.”
Friction point:
Last year, employment was surging in home health care, with an average of 13,500 jobs added each month.
But after the Trump administration immigration crackdown began in January, employment dropped off, falling into negative territory for three consecutive months in the spring, Nestler noted this summer.
This isn’t a matter of demand falling, but a cutoff in supply, he explained.
How it works:
Immigrants make up 1 in 3 workers in home care settings, per data from KFF, a health care research organization.
The severe crackdown this year on undocumented immigrants and the Trump administration’s removal of legal status from workers who are here from Venezuela and other countries are making it hard to find workers, says Mollie Gurian, vice president of policy and government affairs at LeadingAge, an aging-services nonprofit.
“The supply of workers was already so low,” she says. With fewer folks available, the companies that provide these service are raising prices to put pressure on demand. Others are raising prices in anticipation of cuts to Medicaid funding, she says.
The big picture:
At the same time that the supply of people to do this work is falling, the number of Americans who need care is rising, as a silver tsunami of baby boomers ages.
The bottom line:
We are only at the very beginning of a dramatic demographic shift, Nestler says.
Elder care is a “ticking time bomb that no one’s talking about.”
The government shutdown has left many federal workers furloughed, caused nationwide flight delays, left small businesses unable to access loans and put nonprofit services in jeopardy. It’s only expected to get worse.
As Congress remains deadlocked over passing a stopgap measure to reopen the government, thousands of Americans are at risk of losing benefits from the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and other programs at the beginning of November.
An additional burden on Americans is the start of open enrollment for the Affordable Care Act (ACA), also known as ObamaCare, on Nov. 1, where they will see more costly health insurance premium plans unless lawmakers act.
Democrats and Republicans have spent weeks pointing fingers at each other, with no deal in sight. The Senate on Tuesday failed to advance a Republican stopgap measure to end the shutdown for the 13th time, while the House was out of session and President Trump was traveling abroad.
With uncertainty around the shutdown’s timeline growing day by day, here are six ways Americans will start to feel more of the shutdown’s impact.
Federal employees
At least 670,000 federal workers have been furloughed while about 730,000 are working without pay as of Oct. 24, according to data from the Bipartisan Policy Center, a think tank based in Washington, D.C. The center estimates that if the shutdown continues through the beginning of December, federal civilian employees will miss roughly 4.5 million paychecks.
The American Federation of Government Employees (AFGE), the nation’s largest federal workers union, urged Congress to pass a “clean” funding measure known as a continuing resolution to reopen the government. AFGE President Everett Kelley said in an Oct. 27 statement, “No half measures, and no gamesmanship. Put every single federal worker back on the job with full back pay — today.”
“I get where they’re coming from. We want the shutdown to end too. But fundamentally, if Trump and Republicans continue to refuse to negotiate with us to figure out how to lower health care costs, we’re in the same place that we’ve always been,” Sen. Tina Smith (D-Minn.) told The Hill on Tuesday.
SNAP and WIC
The U.S. Department of Agriculture (USDA) said benefits won’t be issued on Nov. 1 for SNAP, a program that helps low-income families afford food. Nearly 42 million Americans rely on SNAP benefits every month, according to data from the USDA.
Though the USDA formed a plan earlier this year that said the department is obligated to use contingency funds to pay out benefits during a shutdown, it has since been deleted. The USDA wrote in a memo this month that the contingency fund is only designed for emergencies such as “natural disasters like hurricanes, tornadoes, and floods, that can come on quickly and without notice.”
Democratic officials in more than two dozen states sued the Trump administration this week, arguing the USDA is legally required to tap into those funds. But House Speaker Mike Johnson (R-La.) has claimed those funds are not “legally available.”
Families who rely on WIC, a program that provides food aid and other services to low-income pregnant and postpartum women, infants, and children younger than 5 years old, could also face trouble. The White House had provided $300 million to WIC to keep the program afloat in early October. But 44 organizations signed on to an Oct. 24 letter from the National WIC Association to the White House requesting an additional $300 million in emergency funds, warning that “numerous states are projected to exhaust their resources for WIC benefits” on Nov. 1.
Military pay
Payday is coming up at the end of this week for members of the military.
Earlier this month, Trump directed Defense Secretary Pete Hegseth to “use all available funds” to pay troops. Officials ended up reallocating $8 billion in unspent funds meant for Pentagon research and development efforts toward service members’ paychecks. The administration also received a $130 million donation from a private donor to help cover military members’ paychecks.
Vice President Vance said he believes active-duty service members will get paid this Friday. But Treasury Secretary Scott Bessent told CBS News’s Margaret Brennan on Sunday that troops could go without pay on Nov. 15 if the shutdown continues.
Senate Democrats blocked a bill sponsored by Sen. Ron Johnson (R-Wis.) earlier this month to pay active-duty members and other essential federal workers.
ACA subsidies
At the center of the shutdown fight is the ACA subsidies, which are set to expire at the end of this year. Democrats have been urging Republicans to extend the subsidies, arguing that ACA health insurance premium costs will increase if no action is taken.
Americans can choose their insurance plans for next year on the federal Affordable Care Act exchange website starting Saturday. An analysis from KFF found that without the subsidies extended, Americans will see their marketplace premium payments increase by 114 percent.
Republicans have been firm in their position of reopening the government first before discussing the ACA subsidies.
“The expiring ObamaCare subsidy at the end of the year is a serious problem. If you look at it objectively, you know that it is subsidizing bad policy. We’re throwing good money at a bad, broken system, and so it needs real reforms,” Speaker Johnson said at a Monday press conference.
Head Start
About 140 Head Start programs across 41 states and Puerto Rico serving more than 65,000 children could go dark if the shutdown goes past Nov 1., according to a joint statement from more than 100 national, state and local organizations focused on childhood education and development.
“Without funding, many of these programs will be forced to close their doors, leaving children without care, teachers without pay, and parents without the ability to work,” the statement says.
Head Start programs are designed to help low-income families and their children from birth to age 5 with a focus on health and wellness services, family well-being and engagement and early learning, according to its website.
Nonprofits
Diane Yentel, president and CEO of the National Council of Nonprofits, told The Hill in a statement that the shutdown has forced many nonprofits to halt their operations because of frozen federal reimbursements and grants.
The nonprofits include those handling wildfire recovery in Colorado, housing vulnerable youth in Utah and helping with conservation work in Montana, Yentel said. Many federal workers without pay have also turned to their local food banks, further putting a financial strain on nonprofits.
“With the November 1 cutoff of SNAP and WIC looming, the situation will get even worse. Nonprofit food banks are already facing rising grocery costs and increased demand, including from federal workers and military families,” Yentel said. “If millions of Americans suddenly lose access to these life-saving nutrition programs, local nonprofits will be overwhelmed, and far too many seniors, children, and families will go without help.”
The Trump administration has made a flurry of recent moves aimed at lowering the cost of prescription drugs, including cutting deals with some of America’s top drugmakers and launching a new website to help consumers shop for the best available prices. We recently asked 10 experts — including health economists, drug policy scholars and industry insiders — to evaluate the likely impact of those maneuvers. Their verdict: Most are unlikely to deliver substantive savings, at least based on what we know today.
So, we followed up: If those moves won’t work, what could the administration do that would make a meaningful dent in America’s drug spending?
Here are three key ideas from the experts:
1. Expand Medicare’s new power to directly negotiate prices with drugmakers.
Compared to Trump’s recent ad hoc approach to cutting confidential deals with individual drug companies, some experts say building on Medicare’s new power to negotiate could offer a more sweeping, and potentially lasting, path to savings.
For example, Trump’s team could use the price negotiations to seek steeper discounts than the Biden administration did. Federal officials could also establish a more transparent and predictable formula for future negotiations — similar to the approaches used by other nations — and publish that framework so private insurance plans could use it to drive better deals with drugmakers, too.
Finally, the White House could urge lawmakers to loosen some of the limits Democrats in Congress placed on this power when they passed the law back in 2022. Medicare can currently only negotiate the price of drugs that have been on the market for at least several years — often after the medicines have already made drug companies billions of dollars.
Ideally, said Vanderbilt professor Stacie Dusetzina, “you would negotiate a value-based price at the time a product arrives on the market” — that’s what nations like France and England do.
2. Identify and fix policies that encourage wasteful spending on medicines.
“There are policies within everything — from the tax code to Medicare and Medicaid to health insurance regulations — that are driving up drug prices in this country,” said Michael Cannon, who directs health policy studies at the Cato Institute.
One example Cannon sees as wasteful: the formula that Medicare uses to pay for drugs administered by doctors, such as chemotherapy infusions. Those doctors typically get paid 106% of the price of whichever medicine they prescribe, creating a potential incentive to choose those that are most expensive — even in cases where cheaper alternatives might be available.
And that, according to Cannon, is just the tip of the “policy failure” iceberg.
The Trump administration is taking early steps to reform at least one federal drug-pricing policy, known as 340B, which lets some hospitals and clinics purchase drugs at a discount. More than $60 billion a year now flow through this program, whose growth has exploded in recent years. But researchers, auditors and lawmakers like Republican Sen. Bill Cassidy have questioned where all of that money is going and whether it’s making medicines affordable for as many patients as it should.
3. Speed up access to cheaper generic drugs.
Generic drugs — cheaper, copycat versions of brand-name medicines — can slash costs for patients and insurers by as much as 80% once they come to market. But this price-plunging competition often takes more than a decade to arrive.
That’s, in part, because drug companies have found a host of ways to game the U.S. patent system to protect and prolong their monopolies. Law professor Rachel Sachs at Washington University in St. Louis suggested Trump not only close those loopholes, but also make its own creative use of patents.
Federal officials could, for example, invoke an obscure law known as Section 1498, she said. That provision allows the U.S. government to effectively infringe on a patent to buy or make on the cheap certain medicines that meet an extraordinary need of the country. Sachs suggested that the drug semaglutide — the active ingredient in Ozempic, Wegovy and several other weight-loss medicines — might make for an ideal target.
“The statutory authority is already there for them to do it,” Sachs said. “It’s not clear to me why they haven’t.”
Semaglutide, which earned drugmakers more than $20 billion last year alone, will otherwise remain under patent in the U.S. until early next decade.
The Trump administration issued an executive order back in April signaling at least a high level of interest in some of these ideas — and a host of others, too. On the other hand, Trump and Congressional Republicans have made moves this year that have weakened some of these potential cost-cutting tools, such as Medicare’s power to negotiate drug prices. A key provision of July’s ‘Big Beautiful Bill,’ for example, shielded more medicines from those negotiations, eroding the government’s potential savings by nearly $9 billion over the next decade.
We should all get a better read soon on just how interested this administration is in cutting prices: Federal officials are expected to announce the results of their latest round of Medicare negotiations by the end of November.
Physicians for a National Health Program (PNHP) — in collaboration with Johns Hopkins University researchers — just released a report titled “No Real Choices: How Medicare Advantage Fails Seniors of Color”. It confirms that the handover of public programs like Medicare Advantage (MA) to Big Insurance doesn’t close racial, ethnic and economic health gaps — it deepens them.
Read Physician for a National Health Program’s report, No Real Choices: How Medicare Advantage Fails Seniors of Color, here.
PNHP’s researchers found that communities of color are being steered into MA plans not because they’re better — but because they’re cheaper upfront. This dynamic, dubbed the “Gap Trap,” means that affordability is driving people into coverage that often denies care, delays treatment and locks them into narrow networks.
“Medicare Advantage squanders billions, harms seniors and exacerbates racial inequities,” Dr. Diljeet K. Singh, gynecologic oncologist and president of Physicians for a National Health Program, said. “Americans need universal health Care which removes profit-motivated conflicts of interest, abolishes co-pays and deductibles, ends prior authorization burdens and guarantees protection from medical bankruptcy.”
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Medicare Advantage is the health care equivalent of the subprime mortgage crisis — except the fine print here is costing Americans’ lives and depleting the Medicare Trust Fund.
The equity illusion
When Big Insurance boasts about “diverse” enrollment in MA, this report reminds us: “Diversity” is often just a buzzword used for PR reasons and has nothing to do with seniors receiving the care they deserve — especially when it is used as cover for a business model that profits from inequity.
Black, Hispanic and Asian/Asian-American beneficiaries are disproportionately concentrated in MA plans that score lowest on quality ratings, while white beneficiaries are more likely to live in counties served by higher-quality plans.
One study found that MA prior authorization requests were denied 23% of the time for Black seniors vs. 15% for their white counterparts.
Despite industry claims to the contrary, racial and ethnic health disparities in the United States are not being reduced by Medicare Advantage.
Studies show that Black enrollees are more likely than white enrollees to choose a 5-star MA plan when offered one. They’re just not offered them as often.
Racial minority enrollees in MA suffer from worse clinical outcomes and face barriers accessing best quality care because of restrictive networks and misaligned financial incentives. Black MA enrollees experience higher rates of hospital readmission compared to their white peers.
The MA paperwork burden isdriving doctors out of practice, worsening access for everyone — but especially in already underserved communities.
MA’s restrictive payment practices aren’t just harming patients — they’re pushing hospitals, especially those serving rural and minority communities, toward the edge of closure. Under-payment or delay of claims by MA insurers causes cascading financial harm in these vulnerable systems.
The big picture
As a reminder, even with the racial and ethnic issues aside, Medicare Advantage already severely restricts seniors’ access to providers, imposes unnecessary prior authorization hurdles that often result in deadly delays and denials — and cost taxpayers at least$84 billionmoreeach year than original Medicare. Meanwhile, original, traditional Medicare does not even have networks; almost all doctors participate and few treatments are subject to prior authorization.
PNHP’s report shows that despite insurers’ endless “health equity” pledges and glossy diversity campaigns, MA remains a rigged game that leaves millions of seniors — disproportionately people of color — with worse access, inferior care and fewer real choices.
Big Insurance’s MA plans are shaped by the same market incentives that have long rewarded exclusion and sorting risk, and – if history tells us anything – sorting has always leaned on racial dimensions. As the report sums it up:
“Regardless of the reasons, any system that traps and harms people — particularly in ways that map onto centuries of racial injustice — cannot be a solution to health inequity.”
HENRY KOTULA 