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Gallup Poll: Public Satisfaction With Health Care Costs Hits New Low

Public satisfaction with the cost of health care plans has hit a record low in a new Gallup poll released Monday—just as GOP legislation begins to go into effect, increasing costs for millions.

The poll found that just 16 percent of respondents are satisfied with the costs of health care—the lowest recorded number in the 24 years that the pollsters have asked the question. In fact, 29 percent of respondents said that cost is the “most urgent national health problem,” followed by access to care at 17% and obesity at eight percent.

Following the passage of President Donald Trump’s “One Big, Beautiful Bill,” Affordable Care Act subsidies are set to expire at the start of 2026, effectively raising the cost of health care for millions. And KFF estimates that, for people with marketplace plans, premiums will double if the credits expire.

No Democrats voted for the bill in the House or Senate.

Respondents who answered "Don't know" are excluded.Chart: Andrew ManganSource: KFF Health Tracking PollCreated with Datawrapper

...

Republicans have also opposed legislative attempts to fix the premium problem before the new year.

On December 11, Senate Republicans opposed a Democratic bill that would have added a three-year premium extension, meant as a stopgap until further congressional action. The proposal was filibustered by the party majority with a vote of 51-48 preventing further debate.

The defeat of the bill falls in line with decades of GOP opposition to health care reform. The party has spent more than a decade trying to repeal the ACA and has failed to offer a serious alternative.

At the same time, Trump has argued that the issue of affordability—which includes concerns about health care costs—is a hoax invented by Democrats. This is not true, and—as polls are showing us—Americans know it.

Reprinted with permission from Daily Kos

With System's Looming Implosion, Health Care Could Dominate 2026 Elections

The GOP Congress’ failure to extend the premium subsidies for ACA plans is just the tip of the iceberg set to rip a massive hole in the nation’s private health insurance market in 2026.

As I’ve reported several times in the past several weeks, private insurance premiums for employer-based plans, which cover 165 million working age adults and their families (half the population), are expected to rise nine percent on average next year — the most since passage of the Affordable Care Act. According to the well-respected Mercer survey, employers plan to reduce that increase to six percent by increasing the co-pays and deductibles in their plans.

In other words, employers plan to shift more of the overall health care cost burden onto employees and their families.

Over the past several decades, employers on average picked up about three-fourths of the the total premiums on their plans. Individual employees picked up the other 25 percent. If that ratio remains the same, employees will see the amount of money taken out of their checks each pay period rise by at least six percent, which is more than twice the inflation rate. And that’s before the increase in their higher deductibles and co-pays.

The high cost of high deductibles

How will workers cope with these increases? More will opt into the high-deductible plan option offered by their employers, which usually come with cheaper co-premiums. About half already take that option.

The young and healthy are more likely to choose that path. They are more concerned about upfront co-premium costs than deductibles or co-pays for health care bills that they are less likely to face over the coming 12 months.

This ongoing movement into high-deductible plans has shifted an increasing share of the overall health care cost burden onto the chronically ill, who are less likely to choose high deductible plans. They are the ones who routinely use health care because of heart disease or arthritis or their ongoing battles with cancer or diabetes. They invariably wind up paying every dime of their deductible, whether it’s high or low.

This ongoing shift into high-deductible plans also affects co-premiums on comprehensive coverage. Since it is the sickest people choose the plans with lower out-of-pocket costs, the rates for those plans usually go up even faster than the average as more and more younger, healthier workers opt into high deductible plans.

This is exactly what Republicans are proposing for the individual and family policies being sold on the exchanges. The GOP plan calls for replacing premium subsidies (which lower costs for everyone based on income) with small health savings accounts (HSAs), whose size will be far below the out-of-pocket deductibles in the lowest cost (bronze) plans on the exchanges.

According to news accounts, the Republicans propose giving everyone purchasing individual or family plans on the exchanges a $1,000 HSA ($1,500 if you’re 50 and over). The typical bronze and silver plans have deductibles of $7,500 and $5,000, respectively, according to the Commonwealth Fund.

If you are young and healthy, that’s an attractive option. What’s not to like about the government putting a grand into a personalized HSA when you don’t worry about getting sick? That will leave the silver and gold plans with the sickest people, and send their premiums soaring. This dynamic is why the unsubsidized individual market with accompanying high-risk pools (established by some states) failed prior to passage of the Affordable Care Act.

A little over a year ago, Donald Trump rode a wave of popular anger about rising prices into the White House. In 2024, the average cost of an employer-based plan rose just four percent, new data from the University of Minnesota’s State Health Access Data Assistance Center shows. That was less than half of what is expected during 2026, Trump’s second year in office.

What’s behind those higher costs?

Venal politicians and employer greed aren’t the root cause of rapidly rising health care costs. Their tactics reflect how powerful people, whether in Washington or the C-suite, ensure their favored constituents (the rich and stockholders, respectively) bear as little of the burden as possible.

For most health care economists, the standard explanation for rising costs sounds like a description of the various peaks of a distant mountain range in a landscape painting. They include:

Rapidly rising drug prices and utilization, especially for pricey weight-loss drugs;
Incessant price increases demanded by hospitals and physician practices, which they blame on labor shortages made worse by the immigration crackdown; higher prices for medical supplies and equipment, some of which is tariff-induced; and higher wages for their employees, who themselves are being hit with higher prices for everything they buy;
The rising prevalence of chronic conditions diabetes, cardiovascular disease and obesity;
Demographics (an aging population); and
Consolidation and monopolization of hospital and insurance markets.

But once you climb onto any one of those mountain peaks and look around, you find that every sector of health care operates like a special interest whose incessant pursuit of higher revenue drives up costs. No one takes responsibility for creating a more efficient, more effective and less costly system.

The drug industry abuses patent monopolies on new therapeutics to delay entry of generics and biosimilars. It charges insanely high prices for new drugs that are barely more effective than previous therapies that are now generic. Its legitimate breakthroughs, like the new gene therapies or targeted cancer drugs that were largely invented in government-funded labs, have prices that threaten to bankrupt the entire system.
Hospitals operate inefficiently. They refuse to rein in overuse of pricey procedures. They are larded with administrative waste and overpay senior executives.
The lowest paid physicians in the U.S. are paid more than their European or Japanese colleagues, while high-paid specialists like orthopedic and cardiovascular surgeons earn three times what primary care physicians — the ones who can prevent people from needing joint replacements and heart operations — earn. Their specialty societies and lobbyists prevent increasing the scope of practice for physician assistants and nurses.
Insurance companies, including pharmacy benefit managers, have largely failed to add value for their 15% add-ons to underlying costs. Insurers largely ignore care coordination and fail to prevent overuse of unnecessary care other than through imposing onerous prior authorization processes that alienate physicians and angers patients. They burdens the entire system with excessive administrative costs.

The Trump administration and the GOP Congress have offered next to nothing to address any of these issues. Drug price negotiations — the one arena where it has taken some steps — simply carries out the legislation that was passed during the Biden administration.

Last week, I offered a bold plan to reform payment policy in the U.S. It was designed to cut through the Gordian knot of those special interests by adopting a single-pricing system tied to global budgets, while at the same time providing instant relief to families suffering the ill-effects of excessive health care costs. It would establish a firm cap of eight percent of income on what households can spend on health care in any given year.

Given the harsh reality that millions of U.S. households are facing when it comes to inflation in general and health care costs in particular, I am mildly optimistic that we will see some people running for office next year including some or all of that plan’s components in their campaign pledges.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from Gooz News

As Health Insurance Premiums Spike, Inequality Worsens -- But There Is A Solution

It’s not just people with Obamacare plans who face huge premium spikes next year. Workers with employer-based plans, which cover nearly half of all Americans, are also getting hit with very large increases in their premiums.

The annual survey by Mercer, a major employer benefits consulting firm, found health benefit costs per employee are expected to rise 6.5% in 2026, which would be the highest increase since 2010. Total plan costs-per-employee will increase nine percent, which employers will partially offset by “raising deductibles and other cost-sharing provisions, which can lead to higher out-of-pocket costs for plan members when they seek care.”

One of those “other cost-sharing provisions” — the one that will hit everyone and not just those who get sick — are the co-premiums for their plans, which are taken each week or month out of their paychecks. Historically, employers pick up about 75 percent of the cost of family plans. So when the total costs goes up 6.5 percent, so does the 25 percent share paid by employees.

How much will that cost workers? According to the Kaiser Family Foundation annual survey of employer-based insurance, the average worker paid $6,850 for a family plan in 2025. A 6.5 percent increase in 2026 will sap paychecks by an average of $445. That’s nearly a one percent reduction in the median worker’s take-home pay.

Source: Kaiser Family Foundation

This has gone on for the decades, and will continue as long as health care costs rise faster than wages. A study published in JAMA Network Open last year calculated lost earnings from the growth in health insurance premiums between 1988 to 2019 cost the average family over $125,000 in inflation-adjusted dollars, or nearly 5% of total earnings over the entire 32-year period.

Low-wage workers bear the brunt

But averages don’t tell the whole story. The income-sapping surge in co-premiums for health insurance hits low-income workers much harder than high-income workers because of the way employers structure their health insurance plans.

Most employers that offer health insurance to their employees provide three plan options. The most expensive is the preferred provider organization (PPO) plan. The middle-priced option is usually a health maintenance organization (HMO) plan, which places limits on provider choice. And then there is the high-deductible plan, which is the least expensive but can leave plan participants with huge and unaffordable bills when they get sick.

Not surprisingly, the lowest cost high-deductible option is most attractive to employers’ lowest-paid workers, who are desperate to hold down their upfront health care costs because they need the cash to pay other bills. Middle-income workers may opt for the HMOs, while upper income employees are the most likely to opt for the PPO plans. They can afford them, and they appreciate the ability to see any doctor they choose.

Most employers unwittingly exacerbate this class stratification in private health insurance. More than three-quarters of employers charge every employee, no matter what their income, the same co-premium within each plan option, according to a 2019 Bureau of Labor Statistics survey. Everyone who choose an HMO plan, for instance, faces the same co-premium. That means lower wage workers are paying a higher share of their income for health insurance compared to others who choose the same plan.

Time to graduate

There is a way to bring greater equity to employer-based health insurance. It is something more employers should consider given the growth in income inequality over the past half century.

They could adopt income-based co-premiums, which are sometimes called tiered co-premiums. In a tiered system, those with the lowest incomes pay lower co-premiums for any of the three choices, while those with higher incomes pay more for the same plans. Tiered co-premiums operate like a graduated income tax.

For example, Honolulu-based Alexander & Baldwin, a real estate firm, dropped its one-size-fits-all co-premium structure in 2023. It established three tiers for its more than 100 employees. A single worker in the lowest salary range paid $42 a month for an HMO plan; the middle salary range paid $67 a month for the same plan; and the highest paid workers paid $92 a month.

Universal tiering of co-premiums — something that could be mandated by federal regulation — will not address the burden placed on all Americans by rising health care costs, which this year are being driven by exorbitant hospital and drug prices, rapid uptake of weight-loss drugs, and soaring costs for imported medical products due to Trump’s tariffs. But it will bring equity when it comes to bearing the burden of those rising costs.

Reprinted with permission from Gooz News

How Trump's Patent Office Appointees And Big Pharma Delay Low-Cost Drugs

What’s the easiest and smartest thing a president could do right now to bring down drug prices? That’s easy. Allow quicker market entry for generic versions of biologics.

What’s the biggest thing the Trump administration has done in recent months to impact biologic prices? It made it far more difficult for biologic generics, better known as biosimilars, to enter the market.

How did that happen when the president is constantly using his Truth Social platform to brag about how much he’s doing to lower the price of drugs? He appointed leaders at the Patent and Trademark Office (PTO) who are imposing policies that will make it far more difficult for biosimilar manufacturers to challenge improperly granted patents.

They are already allowing Big Pharma companies to maintain their illegitimate patent portfolios, known as patent thickets, which they use to deny market entry to cheap, generic competitors. These delays can last for years — even decades — beyond the expiration of an initial patent.

Why is this such a big deal and such a big gift to Big Pharma? While biologics make up only two to five percent of prescriptions (estimates vary), they generated around half of the pharmaceutical industry’s $634 billion in revenue in 2024. When still on patent, the price of individual biologic treatments can reach as high as several hundred thousand dollars per year. But when biosimilars enter the market, patients and their insurers save nearly 80 percent on average, according to a recent study in Health Affairs.

Before I get into the shenanigans at the PTO and how it will delay biosimilars, allow me to share some background for those not familiar with the complexities of the pharmaceutical industry and its biotechnology offspring, which was birthed by government-funded inventions that began in the mid-1970s.

Biologics are large organic molecules produced through genetic engineering that are usually delivered through injection or intravenous drips. Many of the greatest advances in drug therapy over the past half century have been through biologics.

The genomic revolution allowed scientists to replace proteins that patients’ bodies cannot produce because they have organ failure or genetic mutations. Genetic engineers also created monoclonal antibodies that target specific cancer mutations and the blood vessels that feed tumors. Vaccines are biologics. Scientists are now working on gene therapies that may permanently repair genetic birth defects.

Producers of biologics – like all drug makers – get patents on their inventions, a right guaranteed in the Constitution (thank you, James Madison) to promote innovation in “science and useful arts.” The idea was to create a limited period that incentivized creation of new inventions, but eventually ended so patent owners couldn’t use their patent monopoly to permanently levy exorbitant prices.

Patent terms have been changed repeatedly over the nation’s history. In 1994, Congress established a 20-year term for patents that began with the date of filing, an increase from the previous 17 years. In 2010 it added a 12-year guarantee of exclusivity to biologic manufacturers, whose products often remain in development for years after the initial patents are filed.

While that add-on was controversial, potential biosimilar manufacturers embraced the bill because it finally provided them with a pathway for entering the market. They also stood to benefit from the 2011 America Invents Act, which created a streamlined process at the PTO for challenging questionable patents. Instead of long and costly litigation in federal court, patent challenges would be heard by expert judges inside the PTO at a fraction of the cost. Appeals would be heard by an internal appeals board.

Information technology’s role

The impetus for the streamlined challenge process came from leading information technology firms (Google, Amazon, Facebook, etc.) who were being besieged by so-called patent trolls, who would buy or write patents they never intended to use that were similar to cutting edge info-tech technologies. The trolls, often backed by private equity investors, used those patents to file patent infringement lawsuits against well-heeled high-tech firms who had actually developed, patented, and used similar technologies. The goal: To extract huge settlements through patent purchases or licensing fees.

One major user of the new challenge process, called inter partes reviews (IPRs), turned out to be biosimilar manufacturers, who wanted a faster and cheaper way to challenge the patent thickets being erected by Big Pharma and biotech firms. Virtually every company that produces FDA-approved biologics and small molecule drugs (pills and capsules) files follow-on patents at the PTO. Any individual product may win a dozen or more, usually involving small changes in dosages, formulations or routes of administration.

“By creating large patent portfolios, companies can make it more difficult for competitors to enter the market by increasing transaction costs and/or delaying US Food and Drug Administration (FDA) approval,” law professors Sean Tu of the University of Alabama and Ana Santos Rutschman of Villanova University wrote this month in JAMA Health Forum. “Patent thickets can also be leveraged to force competitors to settle litigation, thus delaying market entry, or to enter under unfavorable conditions (such as restricted volume entry).”

One study they cited showed 78 percent of all “new” drug patents are part of a post-approval patent thicket for an already approved drug. This tactic has slowed adoption of biosimilars to a crawl. Fifteen years after passage of the law creating a pathway for biosimilar market entry, there are still fewer than 50 on the market, despite there being over 600 FDA-approved biologics, according to the Association for Accessible Medicines, the trade group for biosimilar manufacturers.

The process sped up during the Biden administration as biosimilar manufacturers increasingly turned to the IPR process to challenge questionable patents. They were aided by the fact that the administrative process at the PTO takes only 12 months and costs about $725,000, according to another recent paper co-authored by Tu. Patent litigation in federal court, by contrast, costs on average over $6 million and takes years to resolve.

Biosimilar manufacturers started racking up an impressive IPR win rate at the PTO. Another recent study showed biosimilar manufacturers won 14 of 20 challenges that were holding up market entry for their products. They eventually won FDA approval and saved patients and their insurers tens of billions of dollars. Five are shown in the following chart.

(Note: The bottom scale (-4 to 4) represents the years before and after a biosimilar manufacturer won a patent invalidation case at the PTO. The solid lines represent five of the more expensive biologics that lost exclusivity over the past decade. In each case, the sharp drop in revenue due to lost sales to biosimilars didn’t show up until a year after the PTO ruled because the Big Pharma firm defending the patents had a year to appeal. The bottom dotted line shows how one representative biologic that didn’t face biosimilar competition more than doubled its revenue over a similar time period.)

Big changes at PTO

But the PTO reversed field this year. PTO acting director Coke Morgan Stewart, who had worked at PTO during the first Trump administration before joining O’Melveny & Myers, a major corporate law firm, began using a process she dubbed “discretionary denial” to block patent challenges. In 2024, the patent appeals board had approved nearly 75 percent of all patent challenges. By September of this year, the first under Trump, that rate had declined to 35 percent, according to another study by Tu, this time with Arti Rai of Duke University and Aaron Kesselheim of Harvard Medical School.

The scholars reviewed Stewart’s decisions and found she had created a novel rationale for dismissing patent challenges. She argued that after six years (about the average age for drug patents being challenged), the patent holder should expect they will no longer be administratively challenged. “Before 2025, the ‘settled expectations’ rationale never even existed,” Tu and his colleagues wrote. “It now accounts for a large percentage of denials and is even used when administrative review petitions raise reasonable technical grounds for invalidation.”

In September, the Senate approved John Squires to run the PTO, though he is not a registered patent attorney. He did chair the Emerging Companies and Intellectual Property practice at Dilworth Paxson LLP in Washington where he represented numerous AI, blockchain, crypto, and financial technology companies. He also made campaign contributions to both of Donald Trump’s victorious election campaigns and more recently to the Never Surrender PAC, which is one of the president’s vehicles for supporting GOP candidates in the 2026 mid-term elections.

One of Squires’ first acts after winning Senate approval was to centralize the IPR decision-making process in the director’s office, thus removing it from the experts who understood the technical issues. He also limited the length of briefs that petitioners could file. Then, in mid-October, Squires announced that “he would personally decide every IPR proceeding,” which cannot be reviewed judicially. He also declared he could issue “summary notices,” that may include little or no explanation for denials.

“By aggressively invoking discretionary denials, the USPTO is subverting an important administrative pathway that Congress specifically created to check weak patents,” Tu, Rai and Kesselheim wrote. Seven lawsuits have already been filed challenging the new policy. They call on Congress to “step in” and “explicitly prohibit denials based on non-merit-based criteria such as ‘settled expectations’.”

This Congress? Fat chance. Look for a dramatic slowdown in the pace of biosimilar adoption over the next few years and for a continuing sharp rise in consumer and payer spending on biologics, the most expensive drugs on the market.

Reprinted with permission from Gooz News

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The high cost of high deductibles

What’s behind those higher costs?

Low-wage workers bear the brunt

Time to graduate

Information technology’s role

Big changes at PTO

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