Fact Brief · Summer 2026
Health Care
Don’t Be Played · A ClaimYourVoterPower.org Fact Brief
What is the issue?
The U.S. spends far more on health care than other wealthy countries, yet many people still struggle to afford care and results are uneven. It isn’t one system but many — what you pay, what care costs, where the money goes, who covers the uninsured, and what a new law changes.
This is a long Fact Brief, but each fact section below stands alone. Read the one you need.
Know the terms
- Premium —
- the fixed amount you pay for insurance coverage each month.
- Deductible —
- what you pay out of pocket each year before insurance starts paying.
- Premium payment —
- what you actually pay after any tax credit. Not the same as the premium.
- Premium tax credit —
- a subsidy that lowers your premium payment. The enhanced version expired 1/1/26.
- National Health Expenditure (NHE) —
- the official count of all U.S. health spending, from every source: government, insurance, and out-of-pocket.
- Uncompensated care —
- care the uninsured receive that no one directly pays for; hospitals, government, and taxpayers absorb the cost.
- Improper payments —
- payments that broke program rules: fraud, billing errors, missing documentation. Most are errors, not fraud.
- The 80/20 rule —
- insurers must spend at least 80 cents of every premium dollar on care, or refund the difference to customers.
Coverage & costs
Covered — and not
In 2024, 92.0% of Americans — 310 million — had health insurance for some or all of the year. About 8%, roughly 27 million, did not.[1]
The price of care
In 2024, the U.S. spent about $15,474 per person on health care — per the government’s own National Health Expenditure Accounts, roughly double other wealthy nations’ average.[2][19]
Care delayed
About 17% of adults reported delaying or not getting care because of cost in 2024.[3]
Worry at the kitchen table
About 4 in 10 insured adults worry about their monthly premium, and 48% worry about meeting their deductible.[4]
ACA Marketplace
Private plans, bought through a government marketplace, with income-based tax credits.
The enhanced premium tax credits (2021–2025) expired 1/1/26. Congress did not extend them; they were not repealed by the 2025 budget law.[20]
Premium payments — what enrollees pay after credits — rose 58%, from $113 to $178/mo.[20]
Deductibles rose 37%, from $2,759 to $3,786/yr — the steepest one-year rise since the Marketplaces opened in 2014. Had plan choices stayed the same they would have risen just 6%; the jump came from people switching to cheaper bronze plans.[20]
Sign-ups fell by more than a million, to 23.1 million — the sharpest single-year drop in raw numbers on record.[20]
Medicare, Part B
The standard premium rose 9.7%, from $185.00 to $202.90/mo. Everyone on Part B pays it.[21]
The annual deductible rose 10.1%, from $257 to $283.[21]
The ~8% whose 2024 income was above $109,000 (single) or $218,000 (joint) pay a surcharge on top — $284.10 to $689.90/mo in total.[21]
Job-based coverage
2025 data; covers about 154 million people under 65.
The average family premium rose 6%, to $26,993/yr — against 2.7% general inflation and 4% wage growth.[22]
Workers paid $6,850 of that out of their paychecks; employers paid the rest.[22]
Medicaid
The 2025 budget law (P.L. 119-21, signed July 4, 2025) takes full effect January 1, 2027 — after Election Day, November 3, 2026. States may start earlier with federal approval, and Nebraska, Montana and Arkansas began enforcing work requirements in 2026.
Jan. 1, 2027 — adults covered by the Medicaid expansion must document 80 hrs/month of work, school, or volunteering. States may start earlier; all must comply by Jan. 1, 2029.[23]
Jan. 1, 2027 — eligibility re-checked every 6 months instead of once a year.[23]
The Congressional Budget Office — Congress’s nonpartisan scorekeeper — projects 7.5 million more people uninsured in 2034 and $886.8 billion less federal Medicaid spending through 2034. These are projections, not measurements.[24]
Most people who lose coverage will still be eligible for it. Of those dropped at the six-month re-checks, CBO expects 30% to be genuinely ineligible. The other 70% lose coverage over missed paperwork, communication problems, or difficulty completing the process.[24]
Who pays for the uninsured
Uncompensated care
Care for the uninsured still gets paid for — often via emergency rooms. This “uncompensated care” ran about $42 billion a year in the mid-2010s; taxpayers covered roughly 80% (about $34 billion), around $1,500 per full-year uninsured person.[16][17]
Emergency Medicaid
About 0.4% of Medicaid spending in 2023 — roughly $3.8 billion — went to emergency care for undocumented immigrants. Undocumented immigrants are barred from Medicare, full Medicaid, and government (ACA) subsidies.[18]
Spending, outcomes & overhead
Administrative costs
U.S. administrative costs run about $925 per person, compared with $245 in comparable countries — per the Peterson-KFF Health System Tracker.[5]
Living longer — ranked last
In 2024, U.S. life expectancy hit a record 79.0 years — still about 3.7 years below the ~82.7-year peer-nation average. The Commonwealth Fund’s 2024 scorecard ranked the U.S. last among 10 wealthy countries on health-system performance.[6][7]
Medicare's error rate
Medicare’s “improper payments” (fraud, billing errors, and payments that don’t meet program rules) were about 6.6% of fee-for-service spending in 2025.[12][13]
Where premium dollars go
Overhead — money not spent on care: government-run Medicare spends about 1 to 2 cents of every dollar on administration. Private insurers may keep up to 15 to 20 cents per premium dollar for overhead, marketing, and profit — a legal cap, not a measured average (actual overhead often runs lower), and they must refund customers if they exceed it.[14][15]
What about waste?
The Journal of the American Medical Association estimated that 25% of U.S. health care spending is waste, or $760–$935 billion a year. Percentages below are shares of total estimated waste, not of all health care spending.[8][9]
- ?28–35% Administrative complexity (billing, insurance paperwork, rules)[8][10]
- ?25–30% Pricing failure (higher-than-necessary prices for drugs, devices, and services)[8][10]
- ?13–18% Failures of care delivery (preventable complications, inefficient care, failure to use best practices)[8][10]
- ?9–13% Overtreatment or low-value care (tests and procedures that add little or no health benefit)[8][10]
- ?6–9% Fraud and abuse (phantom billing, upcoding, kickbacks, identity misuse, false claims)[8][10][11]
- ?4–9% Failure of care coordination (fragmented care that leads to avoidable complications or hospital use)[8][10]
What do the facts say?
- ✔The United States spends much more on health care than peer countries but still leaves many people uninsured or struggling to afford care.[1][2][3]
- ✔Costs rose again in 2026 across ACA, Medicare, and job-based coverage.[20][21][22]
- ✔Most of the 2025 budget law’s health changes take effect after Election Day, November 3, 2026.[23]
- ✔High costs are shaped not only by medical care itself but also by prices, administrative complexity, insurance design, and fraud by both institutions and users.[5][8][10]
- ✔Government-run Medicare spends about 1–2% on overhead; private insurers may keep up to 15–20% of premiums for overhead and profit. Government programs also carry waste — Medicare’s improper payments ran about 6.6% of fee-for-service spending.[12][14][15]
- ✔We pay for the uninsured either way — through emergency rooms and taxes, or through coverage.[16][17]
- ✔Undocumented immigrants receive some emergency care but are not eligible for full Medicaid or ACA subsidies.[18]
Stay current
- KFF Health Costs — nonpartisan charts and explainers on health spending, affordability, insurance costs, medical debt, and barriers to care. kff.org/topic/health-costs
Sources & links
Verified July 9, 2026
Our research process
Every Fact Brief follows the same discipline — so you can trust what’s on these pages, and check it yourself.
Prepared for educational purposes from publicly available sources believed reliable at the time of publication. Readers are encouraged to consult the original sources.
A www.ClaimYourVoterPower.org Fact Brief. Free to print, copy, host, and distribute unaltered, with attribution (CC BY-ND 4.0). Quotation with citation welcome. Published July 2026.