💡 What’s Happening?
Modern health insurance was created to make healthcare accessible. The idea was simple: patients contribute predictable monthly payments, insurance helps cover the cost of care and people can seek treatment when they need it without facing financial ruin. Yet today, that mission is becoming harder to recognize.
Across the country, patients are paying more through premiums, deductibles, copays and coinsurance. While many Texans technically have insurance coverage, an increasing number struggle to actually use it because the out-of-pocket costs are too high.
The result is a growing number of people who are insured on paper but unable to afford care in practice.
“Health insurance premiums rose about 7.5%, climbing from an average of $636 to $684 per month. Out-of-pocket spending grew much faster, jumping 21.5%, from $239 to $291 per month. That out-of-pocket increase is the single largest percentage change among any cost component in the standard, and it reflects a continued pattern of families absorbing more of the price of care directly even when they have coverage.”
Texas 2036: What it costs to get by in Texas in 2026
“Over the past decade, cost-sharing, referred to here as the out-of-pocket portion of household health spending, has grown faster than both workers’ wages and general inflation for those with employer coverage. In recent years, there has been a shift in which cost-sharing is now growing at a rate more similar to inflation.”
Health System Tracker: How much do people with employer plans spend out-of-pocket on cost-sharing?
🧱 The High-Deductible Wall
High-deductible health plans have become increasingly common as insurers and employers look for ways to manage rising healthcare costs. But when plans are designed to shift the risk directly to patients with higher cost-sharing in exchange for lower premiums, everyone loses.
As deductibles and coinsurance have climbed across employer-sponsored and ACA plans, families and patients have been asked to shoulder more of the cost of care themselves. That means paying thousands of dollars out-of-pocket before insurance begins covering a meaningful share of costs.
The consequences are predictable: people postpone annual checkups, they skip preventive screenings and they delay follow-up appointments – but what begins as a financial decision can complicate into a medical crisis only a hospital is equipped and available to handle.
“But the policy at his current job carries an annual deductible of $4,000, which he must pay out-of-pocket for his family’s care until he reaches that amount each year. ‘Now everything is full price,’ said the 53-year-old, who works at a warehouse just south of Dallas-Fort Worth. …To reduce his costs, Garza switched to a lower-cost diabetes medication, and he no longer wears a continuous glucose monitor to check his blood sugar.”
KFF Health News: Out-of-Pocket Pain From High-Deductible Plans Means Skimping on Care
“Texas is one of 19 U.S. states where premium contributions and deductibles for employer-sponsored health insurance plans consume 10% or more of families’ median household incomes, according to new study. …‘If you’re paying out too much, there’s a good chance you end up forgoing care you need because you’re worried you can’t afford it due to your deductible,” [the study author] said.”
San Antonio Current: Texas families pay among largest share of their incomes to cover health premiums, deductibles
💸️ An Out-of-Pocket Dilemma
Informed healthcare consumers are not borne out of taking on more financial risk and responsibility. Healthcare hardly functions like other consumer purchases – the demand is driven by illness, injury and medical necessity, not preferences or the state of the economy.
Because people cannot compare prices while experiencing a stroke, heart attack or deadly injury, they compare pricing on insurance plans to protect them in the event of emergency and help financially support disease prevention. When cost-sharing gets to be too much, patients aren’t making a decision similar to not buying the latest phone or skipping a sports game. They are making a potentially life or death decision – being forced to choose between spending thousands of dollars on their health, or hardly anything at all.
As for uninsured and underinsured patients, hospitals frequently become the provider of last resort. Severe conditions require intensive treatment, which is more expensive and more difficult to deliver. Many are unable to pay back the full cost of their care, and the difference does not disappear, but is shifted throughout the healthcare system, affecting patients, providers and taxpayers alike.
🩹 Policy Considerations
Coverage that patients can’t afford to use isn’t meaningful health insurance, it’s an “only break in case of emergency” button. Determining how healthcare costs are distributed across patients, insurers, employers and providers is a policy question – not an answer for patients deciding whether they can afford necessary care. Coverage models should make healthcare financially accessible and encourage timely treatment.
A healthcare system works best when insurance functions as intended: helping patients obtain care when they need it while providing financial protection from unexpected medical costs.
⭐ Insurance should help patients obtain care when they need it – not create additional barriers to receiving it.
📖 Learn More
Health Insurance Burdens
Insurance Companies Shift Healthcare Costs to Patients
Health Insurance Resources
