IndigenousNetwork was able to attend a briefing from American Community Media focused on the escalating cost of health care in the United States, as millions of people lose coverage or face sharply higher premiums following the expiration of enhanced Affordable Care Act tax credits. The briefing came at a moment when health care spending has overtaken housing and food as the largest pressure on household budgets, a shift with particular consequences for Indigenous communities, where chronic illness, rural access barriers, and economic precarity already intersect.
Sunita Sohrabji, health editor at American Community Media, opened the discussion by noting that roughly 20 million people enrolled in ACA marketplace plans are experiencing what she described as “sticker shock,” with premiums doubling or more for many households. She cited New York Times reporting showing that 1.4 million people have already dropped their coverage, with projections suggesting more than four million could become uninsured in the coming months. The timing matters. Open enrollment has closed in most states, leaving families to choose between lower-tier plans with high deductibles or no insurance at all.
Anthony Wright, executive director of Families USA, framed the spike as the result of deliberate federal policy choices. Families USA is a national health care consumer advocacy organization that has long focused on affordability and access. “On average, it is over a doubling of their premiums,” Wright said, adding that for some households it amounts to tripling or quadrupling costs. He described older couples in their fifties and sixties now facing annual premiums of $10,000 to $15,000. “Millions are now stuck with a massive health insurance premium spike and an awful choice,” Wright said. “Pay more and get less, or go without coverage.”
Wright emphasized that the expired tax credits had capped health insurance costs as a share of income, a safeguard that disappeared at the start of the year. Without it, he warned, the initial wave of people losing coverage is only the beginning. “We think this is just the tip of the iceberg,” he said. He also pointed to the cascading effects of rising uninsured rates, including higher uncompensated care for clinics and hospitals and further premium increases as healthier people drop out of insurance pools.
The economic context was laid out by Dr. Neale Mahoney, a professor of economics at Stanford University and a fellow at the Stanford Institute for Economic Policy Research, who studies health care markets. Mahoney said the United States now spends roughly 18 percent of its gross domestic product on health care, more than double what it spent two generations ago and far more than peer countries. “The most important driver is the prices are too high,” he said. “For everything from drugs to hospital care, we pay higher prices than almost everybody else.”
Mahoney noted that the average annual cost of family health insurance is now about $27,000, a figure that weighs heavily on small businesses and suppresses wages. “Higher health care costs mean lower wages and fewer jobs,” he said, describing a labor market where employers either reduce pay, delay hiring, or drop coverage altogether. For Indigenous workers, who are overrepresented in small businesses, service jobs, and seasonal employment, these pressures compound existing gaps in coverage.
Mahoney also addressed the impact of co-pays and deductibles, pushing back against the long-standing idea that cost-sharing encourages responsible use of care. “What we’ve seen from a generation of evidence is that when you expose people to costs, they cut back not only on care of questionable merit, but on things they need,” he said, including medications for chronic conditions and routine checkups. In Indigenous communities, where rates of diabetes, heart disease, and untreated dental conditions are high, these barriers often translate into delayed care and worse outcomes.
Prescription drug prices were the focus of Meredith Basie, executive director of Patients for Affordable Drugs, a national advocacy group that does not take funding from the pharmaceutical industry. Basie said one in three people in the U.S. cannot afford their medications, and Americans pay four to eight times more for the same drugs than patients in other wealthy countries. “It doesn’t have to be this way,” she said. “It is pharmaceutical corporations who are setting those launch prices and controlling the market through monopolies.”
Basie described recent reforms that allow Medicare to negotiate drug prices, a shift that took effect this year for the first time. She said negotiated prices for the first set of drugs came in about 63 percent lower than previous costs. Still, she cautioned that industry lawsuits and patent practices continue to threaten broader reform. “Drugs don’t work if people can’t afford them,” Basie said, underscoring that even reduced costs can remain out of reach for low-income and fixed-income patients.
Throughout the briefing, speakers returned to the idea that affordability failures are not isolated to individual households but ripple through entire systems. When people lose coverage, emergency rooms become default providers, clinics absorb unpaid care, and insurance markets become more unstable. Wright put it plainly. “This has a cascading impact on increased costs and decreased services for everybody, not just those directly impacted.”
For Indigenous communities, the stakes are sharpened by geography and history. Many Native people live in rural or remote areas where provider shortages already limit access. Others live in urban settings where Indian Health Service eligibility does not guarantee timely care. The erosion of ACA affordability adds another layer to an already fragmented system, particularly for mixed-status families and those working in informal or seasonal economies.
The briefing closed with a shared assessment that short-term fixes are not enough. Wright called for restoring income-based caps on premiums alongside deeper reforms to address high prices across the system. Mahoney pointed to Medicare expansion and stronger competition as tools that already exist but remain politically contested. Basie stressed that public pressure has driven the limited gains achieved so far and will be necessary to defend them.
In Indigenous news, health care is rarely an abstract policy debate. It shows up in clinic closures, skipped prescriptions, and elders choosing between medicine and groceries. The data presented at this briefing makes clear that the current moment is not just about premium increases. It is about whether health care remains accessible at all for millions of people. As costs continue to rise and federal action stalls, the burden shifts downward, to families, to tribes, and to local systems already stretched thin. Documenting these impacts, in real time, may be one of the few tools communities have to insist that affordability is not a privilege, but a public obligation.
