WASHINGTON, Nov. 2, 2026 — Healthcare affordability is among Americans’ leading financial concerns ahead of Tuesday’s midterm elections. Higher insurance premiums, prescription drug prices and out-of-pocket medical expenses are adding to household spending. Disputes over medical billing, pharmaceutical pricing, hospital consolidation and insurance coverage have also brought greater scrutiny to the policies governing healthcare costs.

A KFF poll found that one-quarter of Americans are very worried about their ability to afford healthcare, while more than one-third are somewhat worried. Recent figures show the extent of the expense: the average monthly premium for a benchmark health insurance plan under the Affordable Care Act (ACA) rose from $497 in 2025 to $625 in 2026. The increase followed the expiration of enhanced ACA premium tax credits at the end of 2025.

A KFF analysis published Friday found that finalized benchmark silver premiums under the ACA will rise by an average of 13% in 2027. That would mark the second consecutive year of double-digit premium increases.

Workers with employer-sponsored health insurance are also paying nearly 10% more in premiums. The average deductible for single coverage reached $1,886 in 2025, up 43% from 2015.

Prescription drug spending rose 12.7% in 2025 to $915 billion and is projected to exceed $1 trillion in 2026, according to the American Society of Health-System Pharmacists (ASHP). Prices for the 25 most widely used brand-name drugs have risen by an average of 81% since their U.S. market launches, according to the AARP Public Policy Institute.

ABC News reported on the factors behind rising healthcare expenses and their effect on American households.

Sabrina Corlette, a research professor and founder and co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, does not expect an immediate reduction in healthcare expenses.

“At this point, I am not seeing that there’s going to be any sort of magic bullet in the short term to bring costs down.”

“I hate to be a Debbie Downer here, but I think it’s [going to] get worse before it gets better.”

AI Changes Medical Billing

Hospitals, healthcare providers and doctors’ offices are adopting ambient artificial intelligence (AI) tools to document patient visits, scan laboratory results and generate medical notes. Known as AI scribes, these systems are designed to reduce the administrative burden of clinical documentation. However, analyses by Blue Cross Blue Shield (BCBS) and Trilliant Health suggest that their use may lead to more diagnoses being recorded or discrepancies between the care patients receive and the services listed on their bills.

Zack Cooper, an associate professor of public health and economics at Yale University and director of Yale’s Health Care Affordability Lab, linked the adoption of these tools to changes in medical billing.

“There’s been the adoption of some new AI tools used by providers, and one of the things that seems to be allowing is more aggressive coding.”

More aggressive coding can place patients in higher billing categories and result in larger claims. Corlette experienced this during an annual check-up after her doctor’s office disclosed that it was using an ambient AI scribe. She received a copay for the visit for the first time.

The doctor’s office explained the charge:

“They were like, ‘Well, you asked a question that made your visit no longer preventive. Instead, it became a diagnostic visit, and so that means that you have a cost-sharing obligation.’”

Corlette said the exchange lasted about 20 seconds. The AI scribe recorded it and included it in the medical notes.

“It was literally like a 20-second question and answer that I think normally, if it was just me and my doctor, she probably wouldn't have bothered to put it into the notes.”

“But the ambient scribe picked up that conversation, put it in, and then turned it into a higher code on the claims form.”

Corlette paid the copay. Although AI-assisted documentation may lead to higher claims for insurers, its long-term effect on total healthcare spending remains uncertain.

Insurers have also faced scrutiny over their use of AI in coverage decisions. A lawsuit filed in November 2023 against UnitedHealthcare alleged that a subsidiary used an AI program to deny post-acute care claims without human review. The case remains pending.

UnitedHealthcare maintains that its “predict tool” does not make adverse coverage determinations. The company describes the tool as a source of information for families, caregivers and healthcare providers about the care and services a patient may need while in a facility and after returning home.

“We believe the lawsuit has no merit and we look forward to vigorously defending ourselves,” UnitedHealthcare said.

A 2024 Senate subcommittee report examined post-acute care denial rates in Medicare Advantage plans operated by Humana and UnitedHealthcare. It also found significant increases in denial rates for post-acute care requests subject to prior authorization at CVS after the use of automated tools, predictive technologies or AI became more widespread.

CVS disputed the findings.

“We never use AI to deny claims, but instead to accelerate real-time approvals of prior authorizations, expedite payment to providers and enable our colleagues to deliver more effective and efficient customer service.”

UnitedHealthcare also challenged the report, arguing that it “mischaracterizes the Medicare Advantage program and our clinical practices,” and failed to account for Centers for Medicare & Medicaid Services criteria that “demanded greater scrutiny around post-acute care.”

The company cited the following figures in its defense of Medicare Advantage:

“Compared to beneficiaries enrolled in Original Medicare, Medicare Advantage members experience 45% lower out-of-pocket costs and have more than a 40% lower rate of avoidable hospitalizations and report a 96% satisfaction rating -- all at a lower cost to the Government,”

Healthcare Pricing Disputes

Healthcare industry groups have offered different explanations for higher premiums and medical expenses. Insurers have pointed to hospital consolidation and pharmaceutical pricing, while drugmakers have focused on the role of insurers and pharmacy benefit managers in determining patients’ out-of-pocket expenses.

Chris Bond, a spokesperson for AHIP, the health insurance industry association, attributed higher premiums and out-of-pocket expenses to hospital monopolies, brand-name drugmakers and certain private equity-backed providers.

“Hospital monopolies, brand drugmakers and certain private equity-backed providers are driving up premiums and out-of-pocket costs for American families and employers through their consistent anticompetitive practices and excessive price hikes.”

Bond also described the role of health plans in addressing medical expenses.

“Health plans are doing everything they can to help shield Americans from the full impact of rising costs, but commonsense, bipartisan reforms are needed to address the healthcare affordability crisis.”

Chanse Jones, deputy vice president at the Pharmaceutical Research and Manufacturers of America (PhRMA), argued that drug list prices do not account for the rebates and discounts insurers and pharmacy benefit managers (PBMs) receive.

“Patients do not often benefit directly from these savings due to the insurance benefit design choices of PBMs and insurers -- for example, formulary placement, cost-sharing design and decisions about whether negotiated savings are shared with patients -- which play a central role in determining what patients pay out of pocket for medicines,”

The American Hospital Association (AHA) has defended hospital affiliations, including mergers and acquisitions, arguing that such arrangements can preserve access to healthcare, particularly in rural and underserved areas.

“Affiliation,” including mergers and acquisitions, “can help keep hospitals open and preserve 24/7 access to care, particularly in rural and other underserved communities.”

The AHA has also called for greater scrutiny of corporate health insurers, citing their consolidation and acquisitions of physician practices.

“Policymakers and purchasers should focus on the consolidation and size of corporate health insurers, many of which sit atop the Fortune 500 list and continue to acquire physician practices.”

“The market dominance of these corporate insurers has had negative effects on affordability and access to care.”

Tariffs Raise Medical Expenses

Tariffs imposed by the Trump administration have added to healthcare expenses by raising the cost of imported medical products and raw materials. Corlette said tariffs are not the largest driver of healthcare spending, but they have made goods used by hospitals and other providers more expensive.

“But it is increasing the cost of goods and supplies that hospitals and other providers have to acquire and use, and that does drive up the cost of care.”

The U.S. healthcare system relies on international manufacturers for pharmaceuticals, medical devices and raw materials. The Food and Drug Administration estimates that 78% of manufacturers producing active pharmaceutical ingredients are located outside the United States. The country also imports nearly half of its medical devices.

Hospitals and health systems depend on global supply chains for medicines and other materials. Higher procurement expenses add to providers’ operating costs and may ultimately be passed on to patients.

A study this year by researchers at the Georgia Institute of Technology’s School of Economics and the University of California, Davis, found that tariffs on imported medical products totaled $3.4 billion during the first six months of 2025. Nearly 56% of those costs were passed on to medical facilities and providers, “potentially consumers in the form of higher prices,” according to a Georgia Tech press release.

Cooper said tariffs on goods used to deliver healthcare can affect both treatment expenses and insurance premiums.

“Anything that's facing a tariff that goes into the care production process has become more expensive,”

“That ends up ultimately raising the cost of care and insurance premiums.”

President Donald Trump has defended his tariff policies and at times dismissed concerns about their effect on prices.

The White House has also cited the administration’s Most-Favored-Nation (MFN) drug-pricing agreements as an effort to reduce prescription drug costs. White House spokeswoman Allison Schuster said the agreements link U.S. drug prices to the lowest prices in comparable developed countries and have saved Americans more than $1 billion.

“With all 50 states, Washington D.C., and Puerto Rico signing onto the GENEROUS model to provide MFN drug pricing on Medicaid, these deals are driving the biggest drop in drug prices in decades.”

“The White House continues to work with Congress to pass the President’s Great Healthcare Plan to codify his Most Favored Nations deals and expand drug pricing savings for everyday patients.”

Photo credit: UnitedHealthcare

GLP-1 Drug Spending

The growing use of glucagon-like peptide-1 (GLP-1) medications to treat type 2 diabetes and aid weight loss has become a substantial contributor to prescription drug spending. The Food and Drug Administration first approved a medication in this class in 2014, followed by Wegovy in 2021 and Zepbound in 2023.

An estimated 11% of U.S. adults currently take GLP-1 medications for weight loss, compared with 3% in 2024, according to a Gallup survey published in July.

A 2025 research letter published in JAMA Network Open found that U.S. spending on GLP-1 medications rose by more than 500% between 2018 and 2023, from $13.7 billion to $71.7 billion.

Branded GLP-1 medications typically cost more than $1,000 a month. The drugs accounted for approximately 14% of U.S. prescription drug spending in 2025, according to ASHP. Spending reached about $60 billion each for tirzepatide and semaglutide. Apixaban, a blood thinner, ranked third among prescription drugs, with spending of $29 billion.

Insurance coverage for GLP-1 medications prescribed for weight loss remains limited. A KFF survey found that only one in five large employers cover the drugs for that purpose. Among companies that cover weight-loss medications, 29% described the effect on prescription drug spending as significant, while 27% called it moderate.

Matthew Rae, associate director of KFF’s healthcare marketplace program, said high spending on these medications can affect insurance premiums.

“High spending on GLP-1s can generally increase premiums overall.”

Cooper said generic competition will be necessary to bring prices down. Until generic versions become available, insurers, employers and patients will have to contend with the high prices of these medications.

“I think there’s basically the period between now and when GLP-1s see generic competition that we're [going to] be wrestling with how to afford them,”

“So that’s about 2030. And so, we have sort of three or four years here before the first GLP-1 generic comes online where we're going to have to wrestle with the very, very high prices for these products.”

For voters, the figures point to several distinct sources of healthcare expense: insurance premiums and deductibles, prescription drug prices, medical billing practices, tariffs on imported medical products and the cost of GLP-1 medications. The policy debate ahead of the midterm elections involves how insurers, hospitals, pharmaceutical companies and federal policymakers address each of these expenses.