Care and Costs: What can be done about the price of healthcare?

The feeling that affordability is just out of reach is everywhere. It shows up in childcare, housing, utilities, food, and, of course, healthcare.

Ask five people what a specific medical procedure would cost them, whether an MRI, open heart surgery or having a baby, and you’ll get five different answers, or most likely, “Who knows!” What you owe depends on your plan type, monthly premium plus your deductible, copays, and coinsurance. Don’t forget to factor in the unique rate agreements and discounts every insurer and health system negotiate. When it comes to the cost of care, “it depends” is probably the most specific answer you’ll find.

That uncertainty is hard enough. Rising premiums make it harder. As coverage gets pricier, more people choose high-deductible or limited-benefit plans, or drop coverage altogether. This year, ACA marketplace enrollment fell for the first time in seven years. In Michigan, people covered through the individual marketplace declined by more than 130,000 between 2025 and 2026. That drop coincided with the expiration of enhanced premium tax credits, which made marketplace coverage significantly more affordable, after Congress declined to extend them.

Health insurance is a sort of “green light” for accessing care and an important form of financial protection. Without it, people tend to put off checkups, prescriptions and screenings. A recent KFF survey found that even across insurance statuses, delaying or avoiding care because of cost concerns is most prevalent among women.

Take prescription medication as just one example of how fears about cost affect health outcomes. Going without the medication that helps manage a chronic condition such as diabetes or high blood pressure makes that management harder, and, later, treatment more expensive. A few weeks back, I picked up a prescription that cost me $2 but would have cost $143 if I had not had health insurance.

Coverage protecting people from steeper costs is most evident when we look at declines in medical debt after Michigan expanded Medicaid. Nationally, about 1 in 12 adults has more than $250 in medical debt. In Michigan, the rate is approximately 1 in 11. Although medical debt affects both the insured and uninsured, data shows that those without health coverage disproportionately carry the burden. Recent efforts to forgive Michiganders’ medical debt are likely to most benefit middle-aged and younger adults who, in a 2025 survey, reported having the greatest share of medical debt.

Health insurance isn’t a fix for high healthcare prices, but it can keep one unexpected diagnosis from becoming years of debt.

Ask why healthcare in the U.S. costs so much and you’ll either get another “Who knows!” or you’ll get an earful: an older, sicker population, rising labor costs, consolidation, new drugs and technology…. There’s disagreement about which contributes most to our high costs, but what’s clear is that this burden of high costs is shared. For example, most privately insured people get their coverage through their job, where employers pay a share of the plan cost. This means premium increases affect employers and employees alike. Hospitals absorb costs too. When someone without an ability to pay seeks emergency care, providers are required to stabilize them. But that unpaid bill becomes uncompensated care, which over time erodes operating margins and strains hospital finances.

High healthcare costs do not exist in a vacuum; the financial fallout of a strained budget ripples across the entire system.

Despite the clear value of health coverage and the need to tackle underlying price drivers, federal policy changes — such as the Medicaid eligibility restrictions enacted under the so-called “One Big Beautiful Bill Act” — confuse reducing coverage with reducing costs.

Medicaid is a more than 61-year-old state-federal partnership serving more than 2.4 million Michigan residents. As of August 2026, more than 650,000 Michigan adults have coverage through Medicaid expansion. The successes of Michigan’s expansion program are numerous and include increasing access to routine healthcare, reducing use of emergency services, and reducing uncompensated care and medical debt.

Yet instead of building on these successes, federal law enacted in 2025 will reduce federal Medicaid spending, largely by adding new requirements for adults to keep Medicaid coverage. Work reporting requirements, more frequent eligibility checks, narrower eligibility for some lawfully present immigrants and other federal changes have been framed as protecting program integrity. In reality, these changes increase the likelihood that eligible people will lose coverage and increase state administrative costs by asking caseworkers to process more paperwork more often. Making Medicaid harder to access is not a strategy for lowering healthcare costs. Rather, it will leave more people uninsured while leaving the causes of high costs untouched.

There are solutions, though. At the federal level, restoring the enhanced premium tax credits that lapsed at the start of this year would be one of the most direct ways to improve marketplace affordability and stability. Closer to home, several proposals are moving through the Michigan Legislature. Price transparency, medical debt protections, investment in primary care, prescription drug price reforms and a Basic Health Program are just a handful of state strategies aiming to address the high price of care or protect people from its consequences. None depend on taking coverage away from someone who qualifies.

Managing our health is something we all face, sometimes without warning: a sick-kid visit when the high fever just won’t quit, an urgent care trip to find out whether that fall caused a break or a sprain, or finally deciding it’s time to talk with a professional about your mental health. When those moments come, the first question should not be, Can I afford to get help? Lowering costs and keeping people covered aren’t competing goals. We need both.