Just for some extra clarity/context, GLP-1 coverage (at therapeutic levels for weight loss) under ACA plans isn't a thing, afaik. At least in my region, I evaluated every potential plan and none...
Just for some extra clarity/context, GLP-1 coverage (at therapeutic levels for weight loss) under ACA plans isn't a thing, afaik. At least in my region, I evaluated every potential plan and none of them will cover it. And by not covering it, I explicitly mean that they will not let it go towards your deductible either. So you're forced to go the manufacturer coupon route. $500/mo for Zepbound or WeGovy are the two "cheapest" options currently. So if any insurance company claims ACA coverage of GLP-1s is adding to their costs, they're most likely spouting off bullshit.
ACA offerings have always been bad, and continue to get worse. Providing subsidies on premiums is very good and likely the only way a big subset of people can get coverage. But costs go far beyond premiums.
If someone qualified for the max subsidy and needs to use that for a $0 premium, they will mostly likely end up with a "catastrophic" coverage plan. These are high deductible plans ($12k-$18 annual for a family) that cover almost nothing before you hit that deductible. If you're fortunate enough to be healthy, stay healthy, and have zero health issues, that would work. But sprinkle anything else into the mix and you're quickly getting hefty bills.
Even the plans with more "traditional" coverage are not great. I'm currently paying almost $700/mo in premiums for myself and my partner. Our specialist copay is still $80/visit, we have to pay a large portion of the cost ("coinsurance") for labs, and you better pray to whatever deity you want that you don't need any procedures or advanced labs, as many will be somewhere between $600 to $2500. Prescription coverage is also bad beyond common "preferred generics." There was one occasion where a preferred generic was re-classified as a "non-preferred generic" part way through the plan year, bringing the cost from ~$25 to ~$80. The drug coverage lists are different for ACA plans vs other (employer sponsored) plans.
To contrast, my partner worked for a government agency briefly and qualified for coverage through them. Their premium was $0, adding me was less than $100. Copays were near zero. Labs and procedures had copays instead of co-insurance and nothing was more than $80 (on the extreme high end). Prescription coverage was great, I don't think we ever paid more than $60, even for a "non-preferred brand."
And even though none of the choices of coverage from the healthcare marketplace are "good", number of options continues to dwindle. Our current plan marks the third time we've had an insurance provider drop out of the marketplace. While the first two of these were smaller, and perhaps more regional, our current one is a massive nationwide insurance company, potentially the largest.
So if you're on an ACA plan and receiving subsidies, that means you're poor enough that getting substantial medical treatment will bankrupt you. Removing these subsidies makes it even worse. This leads to more people avoiding medical treatment. The American healthcare system is currently configured, and perhaps even designed, to kill off poor people.
In 2026, businesses will be hit with an increase of 9 percent or more and they are expected to push some of the burden onto employees, according to the research.
For the 24 million enrollees of Affordable Care Act insurance plans, however, the news is far worse. The end of enhanced federal subsidies for that program means that their costs are expected to rise by more than 75 percent next year, according to KFF, the nonpartisan health policy organization.
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Three recent research reports blame the insurance price hikes generally on rising prices and the more liberal use of health care services. All three reports — by Aon, the global consultancy; Mercer, a benefits company; and the Business Group on Health, an industry group — specifically cited the rise of the new obesity drugs as a driver of costs.
“We are seeing a continued surge in utilization” of the GLP-1 drugs, said Debbie Ashford, a chief actuary at Aon and an author of the report. She said use of the drugs rose 92 percent in 2023 and another 56 percent in 2024, and the growth continues this year at a similar pace. These drugs can cost as much as $800 a month.
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As employers seek to limit the bill for GLP-1s, 90 percent of them said they are paying for the drugs only after prior authorization reviews and nearly half are requiring that patients be substantially overweight as determined by BMI, or body-mass index, the Business Group survey said.
Other cost drivers cited in the forecasts include mental health, chronic conditions and cancer.
The other new force behind the price hikes are the expectation of import tariffs, which would boost the price of drugs.
Currently, pharmaceuticals are exempt from the tariffs imposed by the Trump administration, but the Commerce Department is investigating the impact of drug imports on national security and the president has said that planned tariffs on the medicines could rise to as much as 250 percent.
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A document from United Healthcare of New York states that, to account for “uncertainty regarding tariffs and/or the onshoring of manufacturing and their impact on total medical costs, most notably on pharmaceuticals, a total price impact of 3.6% is built into the initially submitted rate filing.”
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While the obesity drugs and tariffs are expected to raise health care costs generally, the most urgent political matter is the fate of the extra subsidies for the 24 million people with Affordable Care Act plans, who could see their premium payments double in January if the subsidies go away. About half of adults with such coverage are small business owners, their employees or are self-employed, according to KFF.
The extra subsidies were first provided during the coronavirus pandemic, intended to make Healthcare.gov coverage more affordable, and have been in place the last five years. During that time, the number of enrollees in Obamacare plans has doubled to more than 24 million, helping to reduce the number of Americans without health insurance. The subsidies have come at a significant cost to taxpayers, however, and extending the subsidies another 10 years would cost $335 billion, according to the Congressional Budget Office.
About 4 million people will drop out of Affordable Care Act plans in the first year after the extra subsidies are discontinued, according to estimates from the Congressional Budget Office. That will leave behind sicker, more expensive patients in the marketplaces and could prompt insurers to hike premiums even more in the future.
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Eleven House Republicans, many of them in vulnerable seats, have signed onto a bipartisan bill to extend the subsidies for another year — enough time to move the issue past the 2026 midterm elections.
Rep. Jen Kiggans (R-Virginia), the bill’s lead sponsor, warned that if the tax credit ends, a Virginia family of four earning $64,000 could see their premiums jump by more than $2,500 a year. A 60-year-old couple earning $82,800 could face nearly $12,000 in higher annual premiums.
Just for some extra clarity/context, GLP-1 coverage (at therapeutic levels for weight loss) under ACA plans isn't a thing, afaik. At least in my region, I evaluated every potential plan and none of them will cover it. And by not covering it, I explicitly mean that they will not let it go towards your deductible either. So you're forced to go the manufacturer coupon route. $500/mo for Zepbound or WeGovy are the two "cheapest" options currently. So if any insurance company claims ACA coverage of GLP-1s is adding to their costs, they're most likely spouting off bullshit.
ACA offerings have always been bad, and continue to get worse. Providing subsidies on premiums is very good and likely the only way a big subset of people can get coverage. But costs go far beyond premiums.
If someone qualified for the max subsidy and needs to use that for a $0 premium, they will mostly likely end up with a "catastrophic" coverage plan. These are high deductible plans ($12k-$18 annual for a family) that cover almost nothing before you hit that deductible. If you're fortunate enough to be healthy, stay healthy, and have zero health issues, that would work. But sprinkle anything else into the mix and you're quickly getting hefty bills.
Even the plans with more "traditional" coverage are not great. I'm currently paying almost $700/mo in premiums for myself and my partner. Our specialist copay is still $80/visit, we have to pay a large portion of the cost ("coinsurance") for labs, and you better pray to whatever deity you want that you don't need any procedures or advanced labs, as many will be somewhere between $600 to $2500. Prescription coverage is also bad beyond common "preferred generics." There was one occasion where a preferred generic was re-classified as a "non-preferred generic" part way through the plan year, bringing the cost from ~$25 to ~$80. The drug coverage lists are different for ACA plans vs other (employer sponsored) plans.
To contrast, my partner worked for a government agency briefly and qualified for coverage through them. Their premium was $0, adding me was less than $100. Copays were near zero. Labs and procedures had copays instead of co-insurance and nothing was more than $80 (on the extreme high end). Prescription coverage was great, I don't think we ever paid more than $60, even for a "non-preferred brand."
And even though none of the choices of coverage from the healthcare marketplace are "good", number of options continues to dwindle. Our current plan marks the third time we've had an insurance provider drop out of the marketplace. While the first two of these were smaller, and perhaps more regional, our current one is a massive nationwide insurance company, potentially the largest.
So if you're on an ACA plan and receiving subsidies, that means you're poor enough that getting substantial medical treatment will bankrupt you. Removing these subsidies makes it even worse. This leads to more people avoiding medical treatment. The American healthcare system is currently configured, and perhaps even designed, to kill off poor people.
From the article:
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