prior authorization practices<\/a> to speed and simplify the approval process.\n <\/p>\n\n Insurers, however, don\u2019t always feel pressured to reduce costs, said Vivian Ho, a health economist at Rice University. For instance, many larger employers hire an insurance company to administer their health benefits but pay their workers\u2019 claims.\n <\/p>\n
\n \u201cThere\u2019s not as much incentive to drive the hardest bargain if you\u2019re not on the hook for most of the increased prices yourself,\u201d Ho said.\n <\/p>\n
\n While the employer, Medicare and Affordable Care Act markets each have some specific reasons for the premium increases, there are many common factors driving up policyholders\u2019 monthly tabs.\n <\/p>\n
\n One top reason is that Americans have been going to the doctor more often in recent years and, in some cases, getting more intensive treatments. This increased utilization stems in part from people deferring care during the pandemic, which has led to diseases being diagnosed in later stages in some patients, experts said.\n <\/p>\n
\n For instance, since the Covid-19 pandemic, more workers have been accessing mental health services \u2013 a benefit that employers have focused on expanding. Some 10.1% of policyholders had a behavioral health office visit in the second quarter of 2025, compared to 7.1% in the same period in 2019, according to a study of employer-sponsored plans by Mercer, a consulting firm.\n <\/p>\n
\n Also, the growth of medical clinics and telehealth providers has made it easier to access health services, said Sunit Patel, US chief actuary for health and benefits at Mercer. Plus, there\u2019s a growing range of providers, such as physician assistants, to treat patients.\n <\/p>\n
\n \u201cYou put that all together and we\u2019re seeing greater utilization,\u201d he said.\n <\/p>\n
\n Another factor is the increase in Americans suffering from chronic diseases, said Hans Leida, a principal focusing on health care at Milliman, an actuarial firm. These include obesity, diabetes, heart and lung diseases, cancer and, among the elderly, Alzheimer\u2019s disease.\n <\/p>\n
\n More than three-quarters of American adults had at least one chronic disease, while more than half had multiple conditions, in 2023, according to research published in the US Centers for Disease Control and Prevention journal Preventing Chronic Disease. The prevalence of obesity and depression increased among young adults between 2013 and 2023, while diabetes, chronic kidney disease and stroke rose among middle aged adults and chronic kidney disease has become more prevalent among senior citizens.\n <\/p>\n
\n \u201cPeople are just not as well,\u201d Leida said, echoing a concern voiced by doctors, insurers, experts and others.\n <\/p>\n
\n Cancer, musculoskeletal conditions and heart disease are the top medical conditions driving up employer costs in recent years, according to a study published last year by the Business Group on Health, an employer advocacy group.\n <\/p>\n
\n Employers are seeing earlier onsets of cancers among workers younger than the recommended ages for screenings, said Jim Winkler, the group\u2019s chief strategy officer. And people are being increasingly diagnosed when the disease is already more advanced.\n <\/p>\n
\n Higher prices, particularly for hospital care, are also driving up premiums.\n <\/p>\n
\n Like insurers, hospitals have also been merging and scooping up other providers of medical services, including doctors\u2019 offices, outpatient facilities and labs. Inpatient care in nearly half of metropolitan areas was controlled by one or two health systems in 2023, according to KFF. And 55% of physicians were employed by hospitals in 2024.\n <\/p>\n
\n Hospital consolidation has led to higher prices, while hospital acquisitions of physician practices also tend to drive up costs, according to a 2022 RAND study. (The report also found that consolidation among insurers results in lower prices paid to providers, but consumers face higher premiums following such mergers.)\n <\/p>\n
\n Health systems often add facility fees or other charges when patients visit doctor offices or other outpatient providers that they own.\n <\/p>\n
\n Many health systems also gain extra pricing leverage because they insist that all their hospitals be in an insurer\u2019s network or none of them, even across different regions, said Larry Levitt, executive vice president for health policy at KFF. Employers want their networks to be reasonably broad, so they are reluctant to say no.\n <\/p>\n
\n \u201cFor large employers or insurance companies that operate in multiple markets, they can be held hostage by these ever-growing hospital systems,\u201d he said.\n <\/p>\n
\n Asked for comment, the American Hospital Association pointed to the statement it released for one of the House hearings. It highlighted consolidation in the insurance market, which it said leads to higher premiums and the shifting of costs to patients and providers.\n <\/p>\n
\n The blockbuster, yet pricey, obesity and diabetes medications have sent pharmaceutical costs skyrocketing.\n <\/p>\n
\n The share of very large firms covering GLP-1 drugs for obesity soared to 43% in 2025, up from 28% the prior year, according to KFF\u2019s latest annual Employer Health Benefits Survey<\/a>. At the same time, nearly 60% of large firms said usage of the medications for weight loss is higher than they predicted, while two-thirds said the impact on their prescription drug spending was \u201csignificant.\u201d\n <\/p>\n\n Several insurers on the Affordable Care Act exchanges cited obesity drugs as pushing up premiums for 2026, according to KFF. At least one, Blue Cross Blue Shield of Massachusetts, said in its rate filing that it is discontinuing coverage of these medications for weight loss in 2026, which will reduce premiums by about 3%.\n <\/p>\n
\n GLP-1 drugs are not the only medicines that are driving up costs. Expensive cancer treatments, gene therapies and other medications are also contributing to premium increases. Higher projected spending on physician-administered drugs, such as chemotherapy, is one of the main reasons why Medicare Part B costs are climbing, according to the latest report from Medicare\u2019s trustees. (Outpatient hospital care is another.)\n <\/p>\n
\n Asked for comment, a leading pharmaceutical industry trade group said insurers are trying to \u201cpass the buck\u201d by tying rising premiums to higher cost for medicines.\n <\/p>\n
\n \u201cThe data clearly show that the largest part of the health care system \u2014 hospital care \u2014 is also the place where costs are the most out of control,\u201d PhRMA said in a statement, pointing to CMS data showing hospital prices rising more than twice as fast as retail pharmaceutical prices since 2007.\n <\/p>\n","protected":false},"excerpt":{"rendered":"Millions of Americans got a nasty reminder this month of just how costly health care coverage is. Workers,…\n","protected":false},"author":2,"featured_media":427614,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":{"0":"post-427613","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/427613","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=427613"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/427613\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/427614"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=427613"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=427613"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=427613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}