Whine and (Say) Cheese: Insurers Facing Spotlight for High Premium Costs

The U.S. government shutdown 2025 may be nearing its end, but the real cost shock of rising insurance premiums is just beginning to hit home. What was once a policy debate in Washington, D.C., is now fueling real anxiety for millions of Americans facing another round of rate hikes. And for the more than one million North Carolinians who rely on marketplace coverage, the stakes couldn’t be higher. 

Last year, more than 95% of North Carolina residents purchasing insurance through the exchanges relied on special government subsidies to help offset the rising cost of health insurance. These enhanced premium tax credits (EPTCs) are set to expire at the end of this year, with premiums rising another 30% on average. What began as temporary relief during a public health emergency has become the only thing keeping many people insured.  

Yet the insurance companies continue to enjoy record profits. 

Even the president took to social media to blast insurance companies for soaring premiums and lack of market competition, blaming them for their role in exacerbating the shutdown debate over extending the EPTCs. And while we know what it feels like to be targeted by cherry-picked data and political grandstanding (remember Medicaid and the One Big Beautiful Bill Act?), he’s not entirely wrong. There is a serious and dangerous imbalance of power among insurers, providers, and patients.  

Blaming the Affordable Care Act for foundational issues with insurance costs is a smokescreen. It doesn’t address other rules and regulations that allow insurers to determine how much they will reimburse for a particular service and when, as well as those that lock in patients for decisions out of their control. Premium costs are the symptom everyone can see. The disease? Insurers' unchecked control over every aspect of the system. 

Here’s what that looks like in practice: A patient can decide to change providers at any time – but when it comes to their coverage, there is no real competition or transparency. If the insurer drops a provider from their network, the patient is stuck waiting for certain periods and conditions to make changes to their plans or enrollment, potentially severing provider relationships and interrupting continuity of care – all in service of some third-party entity’s bottom line. It’s even worse for those receiving insurance through their employer – which as we’ve noted before, is too expensive a proposition for all but a quarter of small businesses in North Carolina to provide. 

Insurers: It's time to take your share of responsibility in what is an all-consuming health care cost crisis in this country. The good news? You won’t be alone. We recognize that truly healing the system requires cross-sector solutions that can only be achieved together. Stop casting blame on everyone (and everything else) and take a look in the mirror. We’ll be there, too, ready to get to work. 

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