Key Facts

• Health insurance in the U.S. is structured as a business focused on managing risk and making profits.
• Confusing rules and denied claims make it hard for patients to use their insurance effectively.
• Financial incentives reward executives and hospitals for controlling costs and increasing patient numbers, not necessarily for improving health.
• The Affordable Care Act requires insurers to spend at least 85% of premiums on medical care or quality, but costs still keep rising.
• Employer-sponsored family health insurance is expected to cost nearly $27,000 in 2025, with workers paying about $6,850 on average.
• About 100 million American adults have medical or dental debt, showing many struggle to afford care.
• Insurance costs rise while patients may avoid using care due to fear of bills.
• Prior authorization rules consume significant time for doctors and staff, often delaying needed medical care.