In July, Congress passed a budget reconciliation bill that, according to almost every major medical association in the country, will result in approximately 10 million Americans losing their healthcare insurance by 2034. This is not speculation; the “One Big, Beautiful Bill” has gutted Medicaid and the ACA, and will increase healthcare premiums starting in 2026.
The country is also facing an affordability crisis (despite President Trump’s denial) that will be exacerbated by these rising healthcare costs. The Commonwealth Fund estimates that around 100 million Americans owe a total of $220 billion in medical debt due to insufficient health coverage.
Recent federal actions will only worsen the debt crisis. House Speaker Mike Johnson and several other Republican leaders have stated that they will not even call a vote on continuing funds for ACA subsidies, essentially guaranteeing that they will expire by the end of 2025. For the millions of Americans who receive health coverage through Obamacare, insurance premiums are going to skyrocket.
For months, members from both sides of the aisle have gone back and forth on the House floor, pointing fingers and filibustering for hours on end. At the end of the day, there is only so much that talking can accomplish (in this case, nothing); why haven’t we seen any actual change? If you’re wondering what Congress is actually focused on, here’s a brief list from the Republican’s proposed “Big Beautiful Bill”:
- (at least) $21.7 billion of military aid to Israel since 2023
- $170 billion earmarked for immigration- and border-related activity in FY25
- $2.3 trillion in tax breaks to the top 10% of income over the next decade
- $1.6 billion to the CBP to fund construction of the border wall
It is not surprising that members of Congress cannot seem to grasp the urgency of the healthcare crisis. Taxpayers cover around 72% of the premium cost for their chosen plans – all congressional healthcare plans are gold-level ACA – and they enjoy lower out-of-pocket deductible and co-pay costs.
It’s not just Congress. In July of this year, a Texas federal court overturned a Biden-era Consumer Financial Protection Bureau (CFPB) rule that made it easier for those seeking loans or credit reports to keep medical debt private. Laws like this serve to protect consumers with medical debt from discriminatory practices when requesting loans.
CFPB research shows medical debt often has very little to do with one’s reliability or creditworthiness. According to the National Consumer Law Center, this debt reporting rule has helped over 15 million Americans with their credit access. When medical debt is no longer considered in credit reports, credit scores increase by an average of 20 points.
As the federal situation worsens, states can step in to alleviate the burden within their jurisdictions. Several states have already established minimum financial assistance standards for low-income families within hospitals, but the process for determining eligibility is often hindered by bureaucracy and long wait times. State-run, centralized financial assistance portals could help streamline the process, prepopulating necessary financial information on applicants who need urgent care.
Medical bills also do not often go straight to patients from hospitals; they pass through third parties, like revenue cycle management companies, to manage the billing process. Debt collection agencies and medical financing firms often partner with hospitals, offering patients products with high interest rates, like medical credit cards, and practicing aggressive collection. Providers often offer deferred-interest medical financing, which can increase debt by 23 percent. Currently, nine states require hospitals to offer income-based payment plans and cap the monthly payment amount. This practice could be extended to debt collectors to protect consumers, as well as limiting their abilities to offer exploitative payment plans.
Healthcare is not a luxury, nor is it a political bargaining chip – it is essential for economic mobility and dignity. When federal leaders choose tax cuts and military spending over medical access, the consequences fall on everyday Americans. States may not be able to replace the federal safety net, but they can take action to prevent its collapse from devastating their residents. State governments must step in as a necessary defense against a system increasingly designed to punish illness.
