President Donald Trump and congressional Republicans are set to tackle the U.S. health insurance system in 2026, aiming to address long-standing issues that inflate costs for American families. As many citizens begin the new year with resolutions to improve their health, the administration is focusing on a more ambitious goal: reforming a system that many believe is fundamentally flawed. Congressional committees are preparing to question insurance executives about practices that contribute to rising healthcare expenses, while the president plans to directly urge these leaders to lower premiums.
The current issues with the health insurance landscape extend beyond mere hearings and discussions, yet these efforts mark a significant starting point. The administration recognizes that the insurance system is at the heart of many healthcare challenges faced by Americans. Insurers wield substantial control over patients’ access to medical services, dictating treatment options, medication prescriptions, and overall care costs. Despite widespread acknowledgment of the detrimental impact of insurers, meaningful reform has been elusive for years.
The insurance industry benefits from substantial taxpayer subsidies, a situation often supported by lawmakers with close ties to the sector. Over time, the system has evolved from a safety net for catastrophic events into a comprehensive bureaucracy that governs nearly every medical transaction. This expansion has led to significant inefficiencies, where administrative complexities hide waste and abuse from public scrutiny. In 2026, the average family plan for two adults and two children on the Obamacare exchanges costs nearly $27,000 in premiums alone. As healthcare costs continue to rise faster than wage growth, projections indicate that by 2032, the average American family may spend 40% of its income on health premiums.
The implications of high costs are severe, impacting both access to care and the quality of medical decisions. Many healthcare professionals have observed how the expanding role of insurers has shifted critical medical decisions away from doctors and patients. Insurers frequently override clinical judgments, determining which treatments and medications patients can access. Additionally, pharmacy benefit managers (PBMs) often guide patients toward higher-cost medications that yield larger rebates for these intermediaries, resulting in increased out-of-pocket expenses for patients, even when equally effective alternatives are available.
In recent developments, insurers and PBMs have exploited a loophole through the creation of offshore Group Purchasing Organizations (GPOs). These entities allow them to route drug transactions in a manner that can potentially evade U.S. tax liabilities while circumventing requirements to pass negotiated rebates back to patients. This practice ultimately leads to higher costs at the pharmacy counter for consumers.
Real reform involves systematic changes aimed at curbing the influence of insurers and PBMs. Lawmakers must prioritize eliminating incentives that inflate drug prices and mandate transparency in coverage decisions. Furthermore, the government should reconsider the allocation of taxpayer dollars to a system fraught with inefficiencies and fraud. In the previous year, the federal government allocated nearly $140 billion to subsidize Obamacare coverage, yet taxpayer subsidies per enrollee have surged by over 50% since 2014 without resulting in significant improvements in care or affordability.
Concerns about waste and abuse are compounded by alarming statistics from the Centers for Medicare & Medicaid Services. The agency revealed that nearly 3 million Americans were improperly enrolled in multiple plans in 2024, leading taxpayers to pay twice for the same healthcare services. Additionally, the Paragon Institute estimates that over 6 million individuals received fully subsidized Obamacare coverage despite being ineligible, highlighting significant flaws within the system.
The history of health insurance reform is reminiscent of Émile Zola’s famous condemnation of systemic fraud and concealment. Today, government officials, policymakers, and insurers are entwined in reimbursement schemes that inflate costs for patient care. Patients in the United States often pay significantly more for identical medications compared to those in Europe, not due to differences in the drugs themselves, but because of the layered fees and opaque pricing structures imposed by insurers and intermediaries.
To shift the focus back to patient needs, it is crucial to reduce reliance on taxpayer-funded insurance for every aspect of healthcare. Expanding the use of health savings accounts could empower patients to make direct spending decisions without the constraints of insurer oversight.
As the new year unfolds, Americans are looking to President Trump and congressional leaders to initiate transformative changes in the health insurance system, prioritizing patient autonomy and financial relief. The call for reform is urgent, with the hope that comprehensive changes will lead to a more equitable and sustainable healthcare landscape in the years to come.
