America is in an affordability crisis. Electricity bills are rising at twice the rate of inflation. Grocery prices are soaring. Tariffs are squeezing families at every turn. And in a few weeks, more than 24 million Americans will see their health care premiums skyrocket. That is, unless Republicans in Congress act to extend tax credits subsidizing plans under the Affordable Care Act.
If the credits expire, the average premium for an ACA marketplace plan will more than double. A 60-year-old couple making $85,000 who get their health insurance through the ACA exchanges will see their out-of-pocket costs exceed $22,000 next year — more than a quarter of their entire income. And all across the country, premiums are increasing for employer-sponsored coverage and Medicare plans as well.
Studies show that the vast majority — close to 80% — of medical debt reports have some sort of error.
The spike in premiums won’t just blow an even bigger hole in families’ future budgets. It will pour gasoline on the already raging fire of medical debt in this country, and government leaders at all levels are not prepared for it.
More than 100 million Americans have some sort of medical debt or dental debt; for more than 15 million, that debt exceeds $1,000. Medical debt is especially pernicious because it almost always comes from circumstances beyond our control — like an illness or injury. No matter how much families plan, save and search for the best health insurance they can afford, a byzantine and profit-maximizing system of hospitals, providers, insurance companies and middlemen leaves Americans scrambling to understand what care they can get and how much they owe — much less how they can afford it.
When millions of people get notices about their premiums doubling on Nov. 1, they’ll be faced with the choice to either go uninsured or enroll in plans with higher deductibles and higher premiums. Both scenarios leave families one fall on the playground or one unexpected trip to the doctor away from massive bills.
When I worked on this issue at the Consumer Financial Protection Bureau during the Biden administration, we discovered that over half of all debts that were put on credit reports involved medical debt. Even more galling, we found that the medical debts reflected on credit reports are often wrong. Studies show that the vast majority — close to 80% — of medical debt reports have some sort of error. This causes millions of people to be harassed by debt collectors into paying bills they don’t actually owe.
The psychological and financial toll that debt takes means that people worry about incurring more, so they avoid going to the doctor and often end up even sicker and with bigger bills than if they hadn’t had debt in the first place. This creates a spiral of health and economic hardship that has ensnared tens of millions of Americans: Medical debt begets more medical debt.
Large corporations are poised to benefit from Trump’s health care agenda. Just think, then, of the ticking time bomb created by the unprecedented health care cuts the Republicans and Donald Trump have spent their first year in office enacting, which will push more than 15 million people off their health coverage. Forcing Obamacare costs to spike will throw millions more off their coverage, pushing them closer to the brink of financial ruin just to stay healthy. Trump’s actions are a slap in the face to the tens of millions of voters who were promised that inflation would be solved on “Day 1.” In poll after poll, Americans list the cost of living and the economy as their No. 1 concern. And Donald Trump and Republicans have done nothing but jack up prices through tariffs, create economic instability that’s brought the job market to a screeching halt and eviscerate the social safety net while giving wealthy corporations a massive tax break. Now, large corporations are poised to benefit from Trump’s health care agenda. With medical debt set to skyrocket as premium increases and Medicaid cuts take effect, debt collectors, medical credit card providers and companies selling predatory financial products will have even more opportunities to squeeze a few more dollars out of stressed and cash-strapped patients. For the typical family, already struggling to deal with a confusing health care system that’s stacked against them, it could be insurmountable. It doesn’t have to be this way. America is the only wealthy country in the world in which getting sick can also mean going broke. If Trump and the Republicans really cared about the health and well-being of working families, they would take steps to make health care more affordable and medical debt a thing of the past. At the very least, they wouldn’t be writing a blank check to debt collectors and big corporations.
Julie Margetta Morgan
Julie Margetta Morgan is the president of The Century Foundation. She was previously a senior official at the Consumer Financial Protection Bureau and the Department of Education. 
