If Congress is serious about lowering health care costs in 2026, insurance reform cannot remain optional.

As Washington turns its attention to health care costs once again, Congress has an important opportunity and obligation to confront a reality millions of Americans already know too well – insurance is getting more expensive while delivering less value.

Tens of millions of Americans face higher premiums, shrinking provider networks, longer wait times for care, confusing coverage rules, and rising out‑of‑pocket costs. Since the pandemic, the average benchmark premium on the ACA exchanges has climbed roughly 30 percent, while employer‑sponsored family coverage now approaches $27,000 per year.

At the same time, more than 80 million Americans are enrolled in high‑deductible plans that require patients to pay the full list price of medicines before coverage even begins. For many families, insurance no longer feels like protection, it feels like a financial stress.

The U.S. insurance market is dominated by a small number of massive, vertically integrated corporations that control insurers, pharmacy benefit managers (PBMs), group purchasing organizations (GPOs), and often the pharmacies themselves. The ten largest insurers now control most of the national market. Blue Cross Blue Shield plans alone account for roughly 43 percent of the commercial market nationwide and hold the largest market share in the vast majority of metropolitan areas. Under federal antitrust standards, an estimated three‑quarters of county‑level commercial insurance markets are considered highly or very highly concentrated.

A Federal Trade Commission analysis found that revenues for a handful of vertically integrated health care conglomerates equaled 14 percent of all national health expenditures in 2016. By 2023, that figure had grown to more than one‑fifth of all U.S. health care spending, exceeding $1 trillion annually.

The same conglomerates that dominate insurance also control nearly 80 percent of the prescription drug market through PBM affiliates. These PBMs and their affiliated pharmacies steer patients within closed corporate silos, mark up drugs, sometimes by more than 1,000 percent and shift more costs onto families and employers.

For patients, the consequences are immediate and personal. Many patients, particularly seniors in Medicare Part D face multiple rejections before finally gaining approval for prescribed medications. Roughly six in ten insured adults report experiencing at least one serious problem with their insurer in the past year, whether due to denied claims, billing disputes, prior authorization delays, or unexpected network restrictions.

Over the next decade, the federal government is projected to pay health insurers and PBMs roughly $16 trillion to administer health benefits. Without reform, taxpayers and patients will continue to finance a system that rewards complexity rather than value.

If Congress is serious about lowering health care costs in 2026, insurance reform cannot remain optional. Hearings must be followed by action that addresses the root causes of rising costs and shrinking access.