Many Americans entered 2026 with intentions to enhance their health. In contrast, President Donald Trump and congressional Republicans have set a far-reaching goal: revamping the health insurance system. Various congressional committees are gearing up to question insurance executives about practices that contribute to escalating healthcare costs. The president intends to exert pressure on these CEOs to lower premiums.
While congressional hearings and negotiations alone may not resolve the issues plaguing the health insurance system, they represent a crucial starting point. Trump and Congress appear to recognize that the insurance framework significantly contributes to the challenges Americans face in healthcare. By addressing these underlying issues, they aim to lay the foundation for essential reforms.
Insurers play a pivotal role in determining which services patients can access, where they can receive treatment, and the cost of their care. Despite widespread recognition of the detrimental effects of insurers, the industry has largely escaped meaningful reform. The insurance sector has flourished on substantial taxpayer subsidies, often backed by Democrats with strong ties to the industry. Over time, it has evolved from a safety net against rare, catastrophic events into a comprehensive bureaucracy that governs nearly every medical transaction.
The excessive bureaucracy within the insurance system, combined with complex administrative layers, obscures waste and abuse, driving up costs for patients. For instance, the average family plan covering two adults and two children on the Obamacare exchanges costs nearly $27,000 in premiums annually. As healthcare expenses continue to rise faster than wage growth, projections suggest that by 2032, the average American family could allocate 40% of its income to health premiums.
High costs represent only one facet of the problem. As a former clinician, I have witnessed how the expanding influence of the insurance system has displaced vital medical decisions from doctors and patients. Insurers frequently override clinical judgments, dictating which medications and procedures are accessible.
Moreover, insurers and their intermediaries, known as pharmacy benefit managers (PBMs), often direct patients to higher-priced medications that yield greater hidden rebates for them, resulting in higher out-of-pocket expenses for patients, despite the availability of cheaper, equally effective alternatives. They routinely impose prior authorization requirements and “fail-first” policies, compelling patients to attempt less effective treatments before accessing the care recommended by their healthcare providers.
Recently, insurers and PBMs have exploited a loophole by establishing offshore entities known as Group Purchasing Organizations (GPOs). This maneuver allows them to route drug transactions through these GPOs, potentially evading U.S. tax liabilities and avoiding obligations to pass negotiated rebates on to patients. As a result, they retain savings while patients face higher costs at the pharmacy counter.
Real reform will necessitate a series of deliberate structural changes. Congress should prioritize curbing the influence of insurers and PBMs by eliminating incentives that drive up drug prices and mandating transparency in coverage decisions. Furthermore, policymakers must cease the flow of taxpayer dollars into a system rife with fraud, waste, and abuse. In the previous year, the federal government allocated nearly $140 billion to subsidize Obamacare coverage, yet taxpayer subsidies per enrollee have surged by over 50% since 2014 without corresponding improvements in care or affordability.
Currently, Medicare Advantage plans frequently offer non-medical benefits, such as ski passes and pet food, at taxpayer expense. This misallocation of funds diverts attention from essential health services. Beyond waste, incidents of outright abuse persist. The Paragon Institute estimates that over 6 million individuals received fully subsidized Obamacare coverage in the past year despite being ineligible. Additionally, the Centers for Medicare & Medicaid Services acknowledged that nearly 3 million Americans were improperly enrolled in multiple plans in 2024, resulting in taxpayers covering the same care twice.
Fraudulent practices, such as “upcoding,” where insurers exaggerate patients’ diagnoses to secure higher government reimbursements, further complicate the scenario. Historical parallels can be drawn to Émile Zola’s infamous “J’accuse,” which denounced a government system that enabled fraud under the guise of institutional self-preservation.
The situation today evokes similar concerns as government officials, policymakers, and insurers remain mired in reimbursement schemes that inflate payments for patient care. Both the United States and Europe depend on the same pharmaceutical manufacturers for life-saving medications. Yet American patients frequently pay substantially more for identical drugs, not due to differences in the medicines themselves, but because of the layers of fees, rebates, and obscured pricing that insurers and intermediaries impose.
To address these challenges, a shift is necessary. Instead of relying heavily on taxpayer-funded insurance coverage for every aspect of healthcare, we should empower patients by expanding the use of health savings accounts. This approach would enable individuals to manage their funds directly, without requiring prior approval from insurers for every decision.
Patients are counting on President Trump and congressional Republicans to lead the charge in reshaping the health insurance system to prioritize their needs. As discussions and investigations progress, the potential for meaningful reform hangs in the balance.
