Health insurance has become yet another item that Americans need but struggle to afford. In the era of prediction market wagers and direct-to-consumer products from wellness influencers, what if patients bet on going without coverage?
If sky-high monthly premiums drive families to drop coverage, the downstream effects could be worse than policymakers or the public might imagine.
Insurance unaffordability made headlines when enhanced Obamacare subsidies expired at the end of 2025, and premiums more than doubled for the average recipient. Americans with employer-sponsored insurance also felt the pain of rising expenses, as they saw a 6% to 7% increase in monthly premiums alone. For some, the monthly insurance premium has surpassed their monthly mortgage payment.
Meanwhile, insurance plans often feel more like a burden than a benefit. Networks are narrowing. Red tape, like prior authorization, is becoming the norm. Long wait times leave patients discouraged from making a follow-up appointment. Coverage costs more than money; it often requires time-consuming processes by both patients and their physicians.
The sticker shock from rising premiums may leave Americans wondering if the value of coverage no longer justifies the price tag. So, it’s no surprise that many are rethinking health insurance altogether.
This reckoning has been a long time coming. Patients’ experience with insurance has become almost universally unpleasant. I hear patients express confusion over in-network services, face hurdles when filling their medications, and struggle to interpret their insurer’s explanation of benefits. Even when physicians are on the receiving end of care as patients, we, too, feel that pain.
But I’m worried policymakers don’t understand where this could lead. As an emergency room physician in the Washington D.C. area, I know the fallout of people forgoing insurance: skipped appointments, delayed preventive care, ignored symptoms, and rationed medication. For patients, this could be the difference between catching cancer at Stage I instead of Stage IV, or suffering a stroke that could have been prevented with blood pressure medications. Nothing’s more disheartening for an ER physician than treating emergency cases that could have been avoided with timely, preventive care.
I do not want scores of patients dropping their insurance coverage. I do not want to see the ER become even more overwhelmed. I do not want our healthcare system to buckle under the burden of expensive, late-stage care.
So, I’m hoping this serves as a sobering moment. As insurers start to see more Americans opt out of coverage, turn toward AI as a substitute for care, or simply cross their fingers and hope they don’t have an emergency, they might want to take heed.
Perhaps this is the moment to rethink their product design. We’ve witnessed game-changing innovation in other industries that affect people’s daily lives. Patients can now order a ride share to visit their doctor because of a warning they received from their smartwatch. Insurance, it seems, has not kept up with the times.
Navigating most insurers’ plans is complicated, especially when you are battling illness. If coverage becomes both indecipherable and unaffordable, ERs like the one I work in will become overburdened, and patient outcomes will worsen.
High healthcare costs are not singlehandedly controlled by insurers. But insurers can start showing their worth by simplifying coverage, improving access to treatments, and removing themselves from decisions that rightfully belong to a patient and physician. They can improve transparency about in-network services and reduce the administrative burden of basic care.
Health insurance — once a simple, necessary tool for basic care — has become an increasingly expensive labyrinth. As Americans reach the breaking point, the spotlight is on insurers. They must now make the case, maybe for the first time in generations, that their protection is worth the price. Can they? Â
Alex Shuster, MD, is a board-certified emergency medicine physician based in Washington, D.C.