#healthcare

Cutting costs by cutting benefits is difficult, but the program can also achieve substantial economies of scale in the prices it pays for health care and administrative expenses—and, as a result, private insurers' costs have grown almost 60% more than Medicare's since 1970.[citation needed][106][original research?][107] Medicare's cost growth is now the same as GDP growth and expected to stay well below private insurance's for the next decade.

Health care spending in the United States, as a proportion of gross domestic product, is significantly higher than in other high-income countries, yet health outcomes are far worse. For example, average life expectancy is lower than in peer countries, while avoidable death rates are higher.

Systemic inequities lead to pronounced disparities in care and outcomes for many racial and ethnic minority groups, low-income families, and rural populations.

Health system challenges include rapidly rising costs caused in part by market consolidation, inconsistent access to primary and specialty care, and administrative complexity.

We support independent research on health care issues and make grants to promote better access, improved quality, and greater efficiency in health care.

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, county indigent health care programs, private insurance, and out-of-pocket payments.

The U.S. is the only developed country without a system of universal healthcare, with around 92% of the population covered under some kind of health insurance for some, or all of the year.

The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP;

In 2022, the United States spent approximately 17.8% of its Gross Domestic Product (GDP) on healthcare, significantly higher than the average of 11.5% among other high-income countries.[

For 2026, across 312 insurers participating in the ACA Marketplaces from the 50 states and the District of Columbia, this analysis shows a median proposed premium increase of 18%, which is about 11 percentage points higher than last year. This is the largest rate change insurers have requested since 2018, the last time that policy uncertainty contributed to sharp premium increases.

key factor driving costs in 2026. Insurers cite increasing cost and utilization of high-priced drugs as well as general market factors, such as increasing labor costs and inflation, as contributing to premium increases.

In addition to rising healthcare costs, the majority of insurers are also taking into account the potential expiration of enhanced premium tax credits in their premium rate increases for the next year. The expiration of enhanced tax credits will lead to out-of-pocket premiums for ACA marketplace enrollees increasing by an average of more than 75%, with insurers expecting healthier enrollees to drop coverage. That, in turn, increases underlying premiums. Other federal policy changes, like the implementation of tariffs and the ACA Marketplace Integrity and Affordability rule were also discussed, though to a lesser extent.

Enrollment in the Affordable Care Act continues to erode as some customers struggle to make premium payments, with the declining numbers churning market uncertainty for insurers. In response, insurers are likely to raise rates again next year, following this year’s larger-than-typical hikes.

A KFF analysis released May 19, for instance, found that the average ACA plan deductible saw the steepest increase in history — growing by 37%, or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired.

Those rising costs pose a political challenge for President Donald Trump and the broader GOP, which has opposed enhanced subsidies to help people purchase Obamacare coverage. Republican lawmakers also passed a spending package last year — enacted as the One Big Beautiful Bill Act — that included provisions expected to reduce ACA enrollment and was cited among factors fueling higher premiums this year.

U.S. vaccination rates have dropped and the share of children with exemptions has reached an all-time high, according to federal data. At the same time, rates of diseases that can be protected against with vaccines, such as measles and whooping cough, are rising across the country.

During his Senate confirmation testimony last year, Kennedy told lawmakers that a closely scrutinized 2019 trip he took to Samoa, which came before a devastating measles outbreak, had “nothing to do with vaccines.”

But documents obtained by The Guardian and The Associated Press undermine that testimony.

Public health experts also criticized the president for making unfounded claims about highly politicized health issues. During a September Oval Office event, Trump asserted without evidence that Tylenol and vaccines are linked to a rise in the incidence of autism in the United States.

Most of the deals, however, don’t affect what people with private insurance or Medicare pay for the drugs. People with Medicaid — who typically have minimal or no copays for prescriptions — already pay very little.

“Generally speaking, most people with insurance coverage will continue to be better off using their insurance to obtain medications rather than purchasing through the TrumpRx direct-to-consumer portal,” said Juliette Cubanski, deputy director of the program on Medicare Policy at KFF, a nonpartisan health policy research group.

The website asks customers to confirm that they are not enrolled in “any government, state, or federally funded medical or prescription benefit programs.” Those with both commercial and government-funded plans are considered to be on government insurance and are not permitted to participate in TrumpRx.

The US has one of the most expensive health systems in the world, with spending on health care estimated to reach $5.9tn (£4.3tn) in 2026, according to the Centers for Medicare and Medicaid Services. But despite spending twice as much per capita on healthcare compared with wealthy nations of a similar size, the US has a lower life expectancy than those other nations, according to health research nonprofit KFF.

Large publicly-traded health companies have tripled their profits over the last two decades, paying out shareholders over $2.6tn from 2001 to 2022, according to a study in the Journal of the American Medical Association. "We are the only major [health] system in the world that allows the free market to run loose," said John McDonough, Harvard TH Chan School of Public Health professor.

Roughly one in five Americans covered by private health insurance reported their provider refused to pay for care recommended by a doctor in 2023, according to a survey by KFF.

The number of overlapping health care systems in the US - Medicare, Medicaid, the marketplace, employer-sponsored insurance and veteran's health, among others - creates a confusing and sometimes wasteful system, said McDonough. "We have so many, each of them with their own set of rules, their own system, their own bureaucracy," he said. "We really do need some system consolidation."

In 2019, differences in diagnostic coding caused Medicare to pay MA plans $9 billion more than it would have spent if the same beneficiaries had been enrolled in FFS Medicare.

Excess payments to MA plans may benefit enrollees in the MA program (when used to increase the value of extra benefits offered rather than increase profits) but cost taxpayers more than if these enrollees were covered in FFS Medicare. Further, excess payments to MA plans increase fiscal pressure on the Hospital Insurance (Part A) Trust Fund as well as on the taxpayers, beneficiaries, and state Medicaid programs who pay premiums to finance the Part B program.

The Medicare Payment Advisory Commission We are a nonpartisan independent legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program.

Fascinating that Medicare Advantage a private company healthcare plan rather than a government one where current political banter beats the drum about fraud. So these are private companies committing fraud and not government run plans.

Medicare Advantage plans offer seniors a private alternative to original Medicare. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, more than half of the people eligible for Medicare.

In court filings, the government argued the health plan “pressured” doctors in Colorado and California to add diagnoses “regardless of whether these conditions were actually considered or addressed by the physician during the patient visits,” policies that violated Medicare requirements.

From 2009 through 2018, KP added roughly half a million diagnoses that generated about $1 billion in improper payments to the health plan, according to the complaint.

The KP settlement comes on the heels of a Senate report this month that accused UnitedHealth Group of “gaming” the Medicare Advantage payment system, which is called “risk adjustment.”

“My investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit,” Sen. Chuck Grassley (R-Iowa) said in a statement accompanying the report’s release.

The report cited several medical conditions that have repeatedly been linked to overbilling by Medicare Advantage plans, such as coding for opioid dependence disorder in patients who are taking their medications as directed for pain.

The updated vaccines have not been specifically tested for safety in people, just as flu vaccines are not tested in people every year with a strain change. The safety of the shots, however, has been well established in the original trials and through surveillance of billions of highly similar doses.

The main serious safety risk of each of the vaccines is inflammation of the heart muscle or its surrounding tissue, known as myocarditis and pericarditis, respectively. The conditions are rare, most commonly affecting young men after a second dose.

Studies have shown that for most people, myocarditis is much more likely following a COVID-19 infection than a COVID-19 vaccine. Infection-related myocarditis is also more severe and linked to worse outcomes.

U.K. health officials analyzed preliminary flu data and predicted that subclade K may spread more easily than other versions. The researchers estimated that the reproduction number of subclade K is 1.4, meaning that each infected person spreads the virus to 1.4 other people on average. Typically, the reproduction number of the flu is closer to 1.2.

While there will be more flu cases this year, so far, there is no evidence that this new flu version will cause more severe cases, hospitalizations or deaths. Health officials have already recorded many more cases this year than at the same time last year, about 4.5 million cases compared to 1.9 million in 2024. But of those nearly two million cases last year, 1.2% were hospitalized and 0.05% died from their infections. So far in 2025, the rate of hospitalization is 1.09% and the mortality rate is 0.04%.

The CDC has not yet commented on the effectiveness of this year’s flu vaccine in the U.S. But U.K. health officials previously estimated that their vaccine, which is different from the one used in the U.S., reduced hospitalizations by about 70-75% in kids and by about 30-40% in adults.

The recent firing of the director of the U.S. Centers for Disease Control and Prevention (CDC) and new restrictions from leaders at the U.S. Food and Drug Administration (FDA) about who will be eligible to get COVID-19 vaccines have sparked confusion among the public and concern from health experts, who say it’s critical to protect as many people as possible from respiratory viruses like flu and COVID-19.

To answer some of your top questions about the 2025-2026 COVID-19 and flu vaccines, we consulted with infectious disease expert, Dr. Michelle Barron.

You can get both shots at the same time, and the exact timing doesn’t matter. So if you’re able to get the updated 2025-2026 COVID-19 and flu vaccines sometime in the next couple of months, Barron encourages as many people as possible to do so.

The panel originally had been scheduled to vote on the COVID-19 vaccine recommendations in June. But that month, Health and Human Services Secretary Robert F. Kennedy Jr. dismissed the committee and installed new members of his choice. The CDC director, who had just been confirmed by the Senate, was fired in August, and other top officials resigned. Meanwhile, Kennedy has repeatedly made false or misleading claims about COVID-19 vaccines this year.

This year, the recommendation by the Centers for Disease Control and Prevention is narrower. Although the vaccines are broadly recommended for adults 19 and older, they are no longer recommended for healthy pregnant people or for healthy children 6 months through 17 years old.

Kennedy announced the changes in a video in May, citing safety risks for young people and pregnant people as justification.

But his claims have been widely disputed by experts in vaccines, pediatrics, and women’s health. An analysis by FactCheck.org found that the secretary “misrepresented scientific research to make unfounded claims about vaccine safety for pregnant people and children.”