Bill McAdams, a 45-year-old travel nurse from Holiday, Florida, was uninsured last year when he experienced a stroke. He hadn\u2019t been able to afford his agency\u2019s health plan, which would have cost $3,600 monthly to cover him and his wife. The hospital that treated him sent him a bill for $93,000.<\/p>\n
Janet Marx, 56, of Milford, Connecticut, has doubled up on insurance coverage through her husband\u2019s employer and Medicare because she has lupus and fibromyalgia, disabling chronic conditions. Still the couple sold their home, the house where Marx grew up, to afford the costs of their medical care.<\/p>\n
Sheila Robinson, 61, in District Heights, Maryland, has a $10,000 deductible on her Affordable Care Act plan, so she tries to negotiate cheaper self-pay options when she sees a doctor. She puts the $659 monthly premium on her credit card, even though she knows not paying the bill in full means she must pay interest.<\/p>\n
\u201cI am just afraid to even go to the doctor,\u201d said Robinson, who has arthritis, a pinched nerve in her neck, and high blood pressure. \u201cEvery month, I am in the hole.\u201d<\/p>\n
This year, KFF Health News has chronicled<\/a> how rising healthcare costs are upending the lives of Americans. Reporters have heard from more than 130 people across the U.S. who are trying to afford their premiums, copayments, prescriptions, and medical bills even as housing, energy, and food costs swell. People told us they are forgoing health insurance coverage, rationing their medications, cutting back on doctor visits, and putting off health procedures.<\/p>\n \u201cWe\u2019re not talking about the uninsured or those who are low-income who are struggling now,\u201d said Rebecca Kirch<\/a><\/a>, executive vice president at the National Patient Advocate Foundation. \u201cNow it\u2019s become an all-of-us issue.\u201d<\/p>\n While healthcare costs have largely grown faster<\/a> than the overall economy for decades, they\u2019ve escalated at a dizzying pace recently. In 2023 and 2024, health spending hit its highest growth rates<\/a> in two decades excluding 2020\u2019s covid-fueled surge.<\/p>\n The prices that hospitals, doctors, and other clinicians charge have increased, along with how much care<\/a> people are getting. Overall health spending hit nearly $5.3 trillion in 2024, up from $3 trillion a decade earlier, according to federal data<\/a>.<\/p>\n American health costs, expected to continue growing faster than the overall economy and help fuel it, are projected to hit 20% of the nation\u2019s gross domestic product by 2032, up from just under 19% today.<\/p>\n Sheila Robinson in District Heights, Maryland, saw the monthly premium payment and deductible for her Affordable Care Act plan skyrocket this year. She pays her premium with a credit card and says she can\u2019t afford to go to the doctor. (Sheila Robinson)<\/p>\n At the same time, Americans are shouldering higher insurance premium payments and other out-of-pocket costs. Low-income and middle-class people with health conditions are feeling the brunt.<\/p>\n The GOP-led Congress decided against extending covid pandemic-era subsidies for Affordable Care Act plans and cut billions from other federal health programs to offset the costs of tax cuts for wealthy Americans and heightened immigration enforcement, arguing that government insurance programs are rife with fraud and waste.<\/p>\n Despite $500 rebate checks sent by President Donald Trump to fewer than 5% of higher-income ACA marketplace enrollees, his administration has been expanding access<\/a> to insurance plans with higher deductibles and lower premiums that push more costs to patients if they need care. Employers are passing along rising healthcare costs to employees, and clinicians are charging patients up front<\/a>.<\/p>\n It\u2019s not all bad news for consumers: Prescription drugs recorded their biggest price drop<\/a> in decades this year. The Biden and Trump administrations both worked to help lower them amid consumer pressure.<\/p>\n But many say they\u2019re still feeling the pain of rising prices. Ahead of the November congressional midterm elections, healthcare costs continue to top a list<\/a> of the public\u2019s worries about affordability, according to polling conducted in mid-September by KFF, a health information nonprofit that includes KFF Health News. Nine in 10 Democratic respondents and three-quarters of Republican ones said the U.S. healthcare system needs either a complete overhaul or major changes.<\/p>\n <\/strong><\/strong>She Sold Her Childhood Home To Afford Healthcare<\/strong><\/p>\n Janet Marx, 56 Janet Marx is on Medicare and has health insurance through her husband\u2019s employer plan. She also receives Social Security disability income because she has fibromyalgia and the disabling autoimmune condition lupus. But she and her husband still struggle to afford their out-of-pocket medical costs. She\u2019s so frustrated about high healthcare costs that she was a guest speaker at an online event for the National Patient Advocate Foundation. Having to scrounge to cover a recent string of $80 copayments for in-home physical therapy led her to an \u201caha moment,\u201d she said. She sold her home, the place where she grew up, and the couple moved into an apartment.<\/p>\n \u201cThings are just getting too expensive to afford the house and health problems,\u201d she said.<\/p>\n \u2014 Renuka Rayasam and Sam Whitehead<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n <\/strong><\/strong>His Premiums Went Up. Now He\u2019s Cutting Back To Make Ends Meet.<\/strong><\/p>\n Damien Waikoloa, 35 Damien Waikoloa wanted to keep health insurance to manage several chronic conditions, even though premium payments for his ACA plan went up to more than $400 a month, from around $240 a month last year. But keeping his coverage meant the small-business owner in Honolulu had to cut back on other spending. He\u2019s trying to reduce the costs of running his business, including considering lowering his own pay. And he\u2019s cutting back on dining out and traveling to visit friends and family in Seattle and California.<\/p>\n \u201cThings like saving for a down payment for a house or even starting a family have completely gone out the window,\u201d he said.<\/p>\n \u2014 Renuka Rayasam<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n \u2018Profit Margins Everywhere\u2019<\/strong><\/p>\n The typical American family spends about $5,600 a year<\/a>, or 9% of their income, on health insurance premiums, out-of-pocket healthcare costs, and taxes that fund health programs, according to the Peterson-KFF Health System Tracker. But overall, the nation\u2019s annual healthcare spending comes to the equivalent of more than $15,400 per person<\/a>.<\/p>\n The reason behind those high U.S. healthcare costs is straightforward: The prices that clinicians, hospitals, drugmakers, and other players in the health system charge are high. For example, while doctors in the U.S. perform about a third as many inpatient knee replacements as in other wealthy nations, the cost per surgery is higher than in most of those countries, according to<\/a> the Peterson-KFF tracker.<\/p>\n More recently, multiple trends have driven that price growth in the U.S., health economists and policy researchers said. Hospitals are merging<\/a> and using their consolidated market power<\/a> to charge more<\/a>. New technologies and therapeutics, such as GLP-1s for weight loss and diabetes, have high price tags. Inflation and the Trump administration\u2019s tariffs are layering costs onto everything from latex gloves to medical devices. And higher numbers of uninsured Americans means fewer people to bear more of the costs.<\/p>\n \u201cIt\u2019s really everything all together at once,\u201d said Christopher Whaley<\/a>, a Brown University health policy researcher.<\/p>\n Why the U.S. has high healthcare prices, however, is more complicated. Whaley and other health economists point to how the American healthcare system is structured and financed. Clinician charges and administrative costs are higher in the U.S. than in other countries. The U.S. doesn\u2019t centrally set all prices for services, ration care, or control for quality.<\/p>\n In most local American markets, insurers negotiate prices with hospitals, clinicians, and drugmakers, which then charge for every test, procedure, or medicine regardless of its outcome. More than half of all healthcare payments were based on this fee-for-service model, according to a 2022 research brief<\/a> published in the journal Health Affairs. Under this model, hospitals and doctors make more as they bill more.<\/p>\n The complexity of different billing systems, rates, insurers, and networks adds to the price tag. The cost of sending out bills and managing paperwork can be hundreds of billions of dollars<\/a>. Insurers try to keep<\/a> medical costs in check, in part by limiting what they\u2019ll reimburse<\/a>. They also take their own cut along the way.<\/p>\n \u201cThere\u2019s profit margins everywhere, and there are varying degrees of financial incentives throughout the healthcare system,\u201d Whaley said.<\/p>\n The incentives, however, don\u2019t necessarily promote better health.<\/p>\n Steven Ullmann<\/a>, director of the Center for Health Management and Policy at the University of Miami Business School, where he\u2019s a professor, said that the country\u2019s health system encourages expensive treatments over low-cost preventive care. He said that keeps people locked into seeing clinicians because they\u2019re in their insurance networks, not necessarily because they produce better outcomes.<\/p>\n Even though people in the U.S. pay more for care than in other countries, Ullmann said higher prices don\u2019t always mean better quality. For example, he said the prices for prenatal ultrasounds in Orlando vary widely with no obvious difference in quality.<\/p>\n \u201cSame city, same procedure,\u201d Ullmann said. \u201cThat is a reflection of a broken system.\u201d<\/p>\n And those high prices can keep people from seeking needed services.<\/p>\n Carmilla Collins in Omaha, Nebraska, had her wages garnished after struggling to pay her medical bills. She almost couldn\u2019t pay rent before qualifying for financial assistance. (Carmilla Collins)<\/p>\n In 2025, a health system garnished the wages<\/a> of Carmilla Collins, 52, of Omaha, Nebraska.<\/p>\n Collins, a single mother, said she didn\u2019t question the tests or medicines doctors ordered when she got diagnosed with thyroid disease or received regular preventive procedures such as a colonoscopy \u2014 until she found herself in debt. The hospital hired a collection agency to sue her for unpaid medical bills that she accrued when she was both insured and uninsured. Then a court allowed the debt collector to take hundreds of dollars out of her paycheck.<\/p>\n Collins remembered being \u201cspitting mad.\u201d She almost couldn\u2019t make rent.<\/p>\n \u201cI\u2019m working two jobs,\u201d she said. \u201cAnd I\u2019m going to be homeless because of this noose that\u2019s around my neck.\u201d<\/p>\n Collins eventually qualified for financial assistance from the hospital, but she said she put off thyroid surgery for four months even as a goiter swelled against her throat, making it hard for her to eat. She had health coverage through her employer at that point but was worried about affording the costs of her deductible and other fees. Eventually, she said, her health declined until she could no longer put off the surgery.<\/p>\n \u201cI equated taking care of my health with debt that I couldn\u2019t afford,\u201d she said.<\/p>\n No Quick Fixes<\/strong><\/p>\n How to slow rising costs \u2014 and overall U.S. health spending \u2014 has long vexed elected leaders and policymakers.<\/p>\n That\u2019s because reducing overall healthcare costs for patients means doctors, hospitals, drug companies, insurers, or other players across the health system would get paid less.<\/p>\n \u201cFor the most part, health spending for us is income to someone else,\u201d said Zack Cooper<\/a>, a health economist at Yale University.<\/p>\n Eliminating administrative complexity or setting price caps \u2014 which is how some countries lower overall costs \u2014 faces steep odds at the federal level. Since 1998, the health sector has spent more than $14 billion lobbying members of Congress in both parties, according to OpenSecrets<\/a>, a nonprofit that tracks money in U.S. politics.<\/p>\n Lynn Ludaway was diagnosed with multiple sclerosis in 2023 and since then the medical bills haven\u2019t stopped. The resident of Evanston, Illinois, says she has racked up tens of thousands of dollars in healthcare bills. (Hannah Norman\/KFF Health News)<\/p>\n After Lynn Ludaway, 40, was diagnosed with multiple sclerosis three years ago, she said, she considered divorcing her husband just to make her eligible for aid to cover medical costs, even though they wanted to stay together.<\/p>\n She initially had coverage through her husband\u2019s job but still faced large out-of-pocket bills. Ludaway, who lives in Evanston, Illinois, also racked up expenses from navigating life with a disabling health condition, such as paying for Uber rides and a cane as her mobility declined. Her medical bills stretched into the tens of thousands of dollars.<\/p>\n \u201cI thought I was well prepared for an emergency,\u201d said Ludaway, who gave up her consulting business and raided her savings and retirement accounts to pay for tests and treatment. \u201cNobody can prepare for this.\u201d<\/p>\n She now pays a $500 monthly premium for coverage through Illinois\u2019 ACA marketplace. But because of her husband\u2019s job, the couple makes too much to qualify for state or federal assistance.<\/p>\n \u201cI am in this weird in-between,\u201d she said. \u201cI need to rest to heal, but I need to work to live.\u201d<\/p>\n Instead Ludaway relies on private financial aid programs, through foundations and the hospital system where she gets her care. She forgoes what she can\u2019t afford, including dental and mental healthcare. She said she must be even more budget-conscious than she was in college.<\/p>\n \u201cBroke undergrad has nothing on chronic illness,\u201d she said.<\/p>\n <\/strong><\/strong><\/strong>This Therapist Accepts Health Insurance. But Affording It for Herself Is Hard.<\/strong><\/p>\n Shayna Sanders, 45 Shayna Sanders, a marriage and family therapist, has bought health insurance through her state\u2019s Obamacare marketplace for more than a decade. In that time, her monthly premium payments have climbed to close to $1,000. She said she has a \u201clove-hate\u201d relationship with insurance companies: They help her make her living by covering her patients\u2019 appointments, but their coverage feels increasingly out of reach for her.<\/p>\n \u201cSome of the health insurance plans that they have, I probably couldn\u2019t afford them myself due to the cost.\u201d<\/p>\n \u2014 Sam Whitehead<\/em><\/p>\n<\/div>\n<\/div>\n Shifting Costs<\/strong><\/p>\n Many current federal healthcare proposals focus on shifting costs rather than lowering them, and ideological differences about who should bear those costs deeply divide lawmakers.<\/p>\n The GOP has prioritized tax and spending cuts, which put the cost more on patients than taxpayers and are expected to boost the number of uninsured, to eliminate what they claim is pervasive fraud<\/a> in government health programs. Last year, Democrats fought to extend enhanced subsidies for marketplace plans, which would buffer patients somewhat from premium hikes by pushing the bill to taxpayers.<\/p>\n Some progressive Democrats, including candidates winning primaries in battleground states<\/a>, are reviving calls for \u201cMedicare for All,\u201d versions of which would create one centralized public insurer. Such a system could end out-of-pocket costs and provide major relief for patients such as Ludaway, but not necessarily cut overall health spending. Clinicians, hospitals, drugmakers, and other groups could still lobby for high prices, which taxpayers would then be on the hook to pay.<\/p>\n And some ideas with broad bipartisan support, such as forcing hospitals and doctors to publicly post medical prices<\/a>, have had little effect on costs.<\/p>\n Policy debates about increasing access to coverage and improving quality of care should also focus on overall health spending, not just who\u2019s picking up the tab, said Michael Chernew<\/a>, a professor of healthcare policy at Harvard Medical School.<\/p>\n \u201cWe don\u2019t have some rich uncle that\u2019s coming and just paying for all of our care. One way or another, collectively we are paying,\u201d Chernew said. \u201cIt\u2019s just we\u2019re shifting who is paying, how much we\u2019re paying, and through which mechanisms we pay.\u201d<\/p>\n Despite trillions in health spending, the nation\u2019s system leaves millions of uninsured and underinsured people unable to afford care. About 27 million people \u2014 nearly 10% of the population under age 65 \u2014 didn\u2019t have health insurance in 2024, according to KFF<\/a>. And the nonpartisan Congressional Budget Office projects that number to grow by 10 million or more<\/a> by 2034 because of policy and funding changes.<\/p>\n Melody Stephens in Berryville, Arkansas, became uninsured when she dropped her ACA marketplace coverage after the monthly premium payments for her and her younger daughter jumped from just over $200 to more than $2,000. As a cancer survivor, she has ongoing medical needs but has been forced to cut back where she can, including stopping her GLP-1 prescription for diabetes. (Melody Stephens)<\/p>\n Melody Stephens in Berryville, Arkansas, became uninsured when she dropped her ACA marketplace coverage for this year after the monthly premium payments for her and her younger daughter jumped from just over $200 to more than $2,000. Stephens, 55, a geriatric nurse at an assisted living facility, said she also couldn\u2019t afford the $1,000 monthly premium payment for her employer-sponsored plan.<\/p>\n \u201cThere was just no way I could do that,\u201d Stephens said. \u201cThat was just not feasible.\u201d<\/p>\n Stephens first got an ACA plan after she was diagnosed with anal cancer about a decade ago. Even with coverage, she filed for bankruptcy two years ago. While her plan largely covered cancer care, it left her with big bills for treatment<\/a> of the side effects of radiation.<\/p>\n Now she and her daughter are relying on financial assistance and cutting back on care. When her daughter, a college student, had some surgeries, the hospitals wrote off the bills, Stephens said. But they still owe money for tests and treatments.<\/p>\n Stephens also stopped taking a GLP-1 that she was prescribed for diabetes and a medication for nerve pain because of the cost. Stephens can\u2019t afford a colostomy<\/a>, so she lives with incontinence, she said.<\/p>\n She said she wishes lawmakers in Washington would fix the healthcare system. \u201cThey just seem to fight,\u201d she said.<\/p>\n A Tipping Point?<\/strong><\/p>\n Next year, insurers say they expect to hike premiums for ACA marketplace plans by 15%, the second year in a row of double-digit premium increases. Employer health costs are expected to rise 9.5%<\/a>, likely increasing the burden on workers.<\/p>\n Policy researchers and economists who have studied health costs say they are skeptical that federal lawmakers are ready to tackle overall health spending, even as the midterm elections loom.<\/p>\n But pressures are building, said Michael Cannon<\/a>, a health policy analyst at the libertarian Cato Institute. \u201cWe cannot stay on this path forever,\u201d he said.<\/p>\n The pain of high costs is felt throughout the economy, including by employers and state governments that help foot the bill for medical care. That reality is giving way to policy proposals that buck some past political positions.<\/p>\n Last year, the GOP-led legislature in Indiana<\/a> capped how much some nonprofit hospitals can charge patients covered by employer health plans. Starting in 2029, five of the state\u2019s largest nonprofit hospitals risk losing their tax-exempt status if they charge those patients more than the price limits. And this year, Texas Republican Gov. Greg Abbott proposed capping certain drug prices<\/a>. Both cost-control efforts, along with Trump\u2019s plans to lower prescription drug prices, are traditionally more the domain of left-leaning politicians.<\/p>\n For McAdams, the nurse in Florida, dealing with high health costs took a physical toll. He believes a subsequent stroke he experienced was caused by the stress of haggling over his hospital bill.<\/p>\n After his first stroke in September 2025, McAdams bought insurance, but it didn\u2019t cover preexisting conditions. In March, he started experiencing problems with his vision and balance. He went to an urgent care center, instead of the emergency room.<\/p>\n \u201cI was so afraid of dealing with the billing issues again that I did not want to go to the emergency room,\u201d he said.<\/p>\n Then, after talking with the hospital regarding his stroke bill later that month, he said, he experienced problems again and landed back in the ER anyway \u2014 with the second stroke.<\/p>\n Now he is applying for Social Security Disability Insurance because he can no longer work as a nurse. The health system eventually lowered his total bill to $50,436 \u2014 but that\u2019s still more than he can afford without a steady salary. He and his wife are also expecting a baby this fall.<\/p>\n McAdams was once proud to be part of the nation\u2019s healthcare system, which saved his life and those of so many others. But the financial stress has changed his view. Now, McAdams said, his trust in it is gone.<\/p>\n <\/strong><\/strong>He Said Medical Debt Caused His Second Stroke<\/strong><\/p>\n Bill McAdams, 45 In March, Bill McAdams started experiencing problems with his vision and balance and went to an urgent care center, instead of the emergency room. He said he feared getting saddled with medical bills on top of one he already had from a stroke he had experienced while uninsured months earlier. Later that month, after getting upset while talking with the hospital regarding the bill from his stroke, he said, he experienced problems again and landed back in the ER \u2014 with a second stroke. Now he owes even more money.<\/p>\n \u201cDue to all the stress, it delayed me in seeking care,\u201d he said. \u201cI didn\u2019t want to deal with the stress of more hospital bills.\u201d<\/p>\n \u2014 Sam Whitehead and Renuka Rayasam<\/em><\/p>\n<\/div>\n<\/div>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage? <\/em>Click here<\/em><\/a> to contact KFF Health News and share your story.<\/em><\/p>\n<\/div>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" Bill McAdams, a 45-year-old travel nurse from Holiday, Florida, was uninsured last year when he experienced a stroke. He hadn\u2019t been able to afford his agency\u2019s health plan, which would have cost $3,600 monthly to cover him and his wife. The hospital that treated him sent him a bill for $93,000. Janet Marx, 56, of…<\/p>\n","protected":false},"author":0,"featured_media":16312,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16311","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16311"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16311"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16311\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/16312"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16311"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16311"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16311"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Milford, Connecticut<\/strong><\/p>\n
Honolulu, Hawai\u2018i\u00a0<\/strong><\/p>\n
New Haven, Connecticut<\/strong><\/p>\n
Holiday, Florida<\/strong><\/p>\n