Congress needs to prioritize patient choice in 2026

The cost for Americans to purchase “insurance” via the ACA, their employer or individually has continued to rise. Many are blaming that rise on a lapse in subsidies for ACA exchange plans.

But the facts suggest the exact opposite. More subsidies are an unproductive band-aid solution for a structural problem in health care that’s driving up the underlying costs: Patients don’t have control over their own health care dollars. 

Instead, patients are stuck with substandard coverage and watch their hard earned dollars and taxes go to fund administrators and billing departments instead of care. 

America cannot prevent the upward spiral of overall health costs until we empower patients with the ability to control and direct their money for their own medical care. 

Congress can start by actually listening to patients about what flummoxes them in our health care quagmire. The vast majority of Americans believe the health care system is rigged against them. 

It’s easy to see why: Government programs, insurance companies, and large hospital systems all seem to prioritize the business side of care over the human side. Administrators now outnumber doctors in major healthcare settings by a ratio of ten-to-one. Large hospital systems continue to buy up smaller practices every year, raising prices and lowering quality.

Lawmakers seem to forget that these power-hungry corporations aren’t afterthoughts of bad policy. In fact, overfed third parties — which include insurers and government programs — are driving the costs. Lawmakers also forget that they represent the people and not corporations.

We’ve seen what happens when consumers are left without any choices other than ACA plans, a problem created when the government granted insurance companies the role of providing these plans. ACA premiums have risen each year, except for the years between 2018 and 2022. Deductibles have followed the same trend, with an even sharper rise in private insurance metrics. Americans were promised affordable care in 2010, but since the ACA was instituted, we are paying more for less, as everyone, especially the most vulnerable are often unable to get care.

It defies logical thinking that U.S. House Democrats, plus seventeen Republicans, passed a three-year extension of the ACA subsidies, thereby continuing to send money directly to the very companies that Americans distrust most. What’s worse is that many know there is a better way forward than continuing to subsidize failure and poor patient outcomes.

A better way is to fund people directly. Take away control and dollars from insurance companies and return them to the patients who need them and can best choose based on their individual needs. 

It’s a commonsense solution that has not been addressed by politicians and policymakers until now. Americans hopefully had a thunderclap realization that when they control their own money, less of it is gummed up in the complex machinery created by insurers and the government. Even better: Patients can direct their dollars to choose the kind of personal medical care that everyone craves. 

With policies like government-funded health savings accounts (HSAs), the options are limitless. Americans can pay for doctor’s visits, purchase prescription drugs, or save the money if they don’t require them. In one fell swoop, lawmakers can develop a tool for financial freedom while putting patients in the driver’s seat of their own care.

Last year, Senators Bill Cassidy (R-LA) and Mike Crapo (R-ID) unveiled a plan that involved government-funded HSAs as a load-bearing pillar. President Donald Trump’s Great Healthcare Plan included similar language, as the president has been a champion of sending health care dollars “directly to the people.”

Lowered costs are just the start of the benefits of giving patients’ power back. Such policies have effects far beyond what patients can see when they open their health care bills. When patients control the dollars, patients can shop for value, and those who care for them will need to compete for their business. Health care price transparency, a bipartisan ask for decades, could open a free-market renaissance in healthcare . 

The time to act is now. Leaders in Congress and the administration will need to move ahead with meaningful health reform before Capitol Hill morphs.

Lawmakers hear this: Put patients in control in 2026 and empower them with choices before America locks itself into another toxic relationship with health care mediocrity.

Marion Mass, M.D., is a practicing pediatrician in Bucks County, a leading member of the Free2Care movement, and a member of The Independence’s advisory board.