Experts warn that the expiration of Affordable Care Act tax credits, rising premiums, and record-high drug prices are deepening access gaps and placing growing strain on seniors and low-income fam.
A new government move is threatening the health of the most vulnerable in the United States. The expiration of enhanced Affordable Care Act (ACA) tax credits, combined with soaring insurance premiums and record drug prices, is pushing millions of Americans out of health coverage, experts warned during a briefing organized by American Community Media.
One out of every five dollars spent in the United States is tied to health care. The sector now represents 18% of the country’s Gross Domestic Product, a figure that continues to rise and is placing increasing pressure on household budgets, small businesses, and the federal government alike. That reality framed the discussion at How Soaring Costs Are Reshaping Health Care Access, the first in a three-part affordability series hosted by American Community Media (ACoM).
The immediate trigger is the expiration of the expanded ACA premium tax credits. With the close of the open enrollment period, millions of people are now locked into plans whose monthly premiums have, in many cases, doubled or even tripled.
“We’re seeing average increases of up to $1,000 a year, but in thousands of cases premiums have doubled, tripled, or quadrupled,” warned Anthony Wright, executive director of Families USA. “People who were paying five or ten dollars a month are now paying hundreds.”
According to figures cited during the briefing and recently reported by The New York Times, at least 1.4 million people have already dropped their ACA coverage. Projections are even more alarming: up to eight million Americans could lose health insurance in the coming months if urgent federal action is not taken.
Wright described the situation as “an avoidable crisis.” He explained that the expired tax credits had capped the share of income families were required to spend on health insurance—roughly 8% annually. “That protection disappeared in January, and what we’re seeing now is just the tip of the iceberg,” he said.
A domino effect on families, businesses, and hospitals
The problem extends far beyond those who lose coverage. A mass exodus from the ACA marketplace threatens to destabilize the entire system. “When healthier people leave the insurance pool, risk concentrates and costs rise for everyone,” Wright explained. “That creates a domino effect: higher premiums, fewer services, and more pressure on hospitals and community clinics.”
Small businesses are among those hardest hit. “For many employers, the third option is simply not offering health insurance at all,” said Neale Mahoney, an economist and professor at Stanford University. “That affects productivity, wages, and hiring decisions.”
Mahoney placed the crisis in historical context. “Over two generations, health care spending has grown from 8% to 18% of GDP. The U.S. spends twice as much as other wealthy countries, not because we’re sicker, but because we pay much higher prices,” he said.
The average annual cost of family coverage is now about $27,000, “the equivalent of buying a new car every year,” Mahoney noted. For employers, especially small businesses, that translates into lower wages, hiring freezes, or layoffs.
Beyond premiums, copays and deductibles have become another critical barrier to care. “The evidence shows that when copays rise, people don’t just cut unnecessary care, they also stop essential treatment,” Mahoney explained. “They skip medications for diabetes or high blood pressure and avoid preventive checkups. In the long run, that ends up costing the system more.”
The economist was blunt: the cost-sharing model has proven to cause more harm than good and should be eliminated for essential medical care.
Prescription drugs: a crisis without an easy fix
The briefing also examined one of the main drivers of rising costs: prescription drugs. Merith Basey, executive director of Patients for Affordable Drugs, was unequivocal. “One in three Americans cannot afford their prescription medications. On average, people in the U.S. pay four to eight times more than patients in other high-income countries.”
According to Basey, the root of the problem is clear. “Pharmaceutical corporations set the prices and control the market through monopolies. For years, Congress allowed these practices to continue,” she said. Unlike other countries, the U.S. has historically failed to systematically negotiate drug prices, leaving patients exposed to launch prices “with little connection to real value.”
Basey pointed to Medicare’s recent drug price negotiations as a significant step forward. Since January, ten high-cost medications—including treatments for diabetes and cancer—have seen average price reductions of 63%. “That’s good news, but it’s not enough,” she cautioned. Even with annual out-of-pocket caps of $2,000, many low-income patients still face crushing financial burdens.
A political debate still unresolved
All three speakers agreed that the crisis is as political as it is economic. “This shouldn’t be a partisan issue,” Wright said. “Millions of people are asking for help right now.”
Mahoney added that while programs like Medicare, Medicaid, and drug price negotiation work, expanding them requires confronting powerful economic interests. “What families experience as expenses are profits for certain industries,” he said.
The briefing concluded with a call to restart a broader conversation not only about restoring ACA tax credits, but about affordability, access, and regulation across the health care system. As Wright summed it up, “Extending the credits should be the starting point, not the end, of the debate over health care in the United States.”