V-BID Update: Cost-Sharing Reforms, Medicare Protections, and Barriers to Care

In this Issue:

• Georgetown Report Recommends Healthcare Affordability Reforms
• Shaheen Urges Senate Action on $35 Insulin Cost Cap
• Healthcare Costs Among Voters’ Top Midterm Concerns
• Financial Impact of Out-of-Pocket Caps in Traditional Medicare
• 91% of Insurance Premium Growth Driven by Rising Healthcare Spending
• Commonwealth Fund: Nearly Half of Adults Are Inadequately Insured
• Delayed Care Worsens Health for Adults With Chronic Conditions
• Study Links Medical Debt to Advanced Cancer Diagnoses
• Individual Health Insurance Enrollment Fell 18% in 2026

Georgetown Report Recommends Reforms to Improve Health Insurance Affordability

A report from the Georgetown University Center on Health Insurance Reforms recommends capping annual deductibles at $1,000 for individuals and $2,000 for families, and out-of-pocket maximums at $4,000 and $8,000, respectively. Reflecting V-BID principles, the report also proposes eliminating cost-sharing for select high-value services, alongside hospital price limits, prior authorization reforms, and stronger consumer protections to improve affordability and access to care.

Senator Shaheen Urges Senate Action on $35 Insulin Cost Cap

Sen. Jeanne Shaheen is pressing the Senate to pass the bipartisan INSULIN Act of 2026, which would cap monthly out-of-pocket insulin costs at $35 for privately insured patients and establish a pilot program extending the same protection to uninsured individuals. The legislation, which advanced through a Senate committee in July, also includes measures to increase insulin market competition and require pharmacy benefit managers to pass manufacturer rebates to health plans.

KFF Poll Finds Healthcare Costs Among Voters’ Top Midterm Concerns

A new Employee Benefit Research Institute (EBRI) survey found that many employees lack both understanding of voluntary benefits and the financial resources to manage unexpected medical expenses. Only 34% of workers said they were very prepared for a $500 unexpected expense, while 47% reported at least moderate financial difficulty from medical events and 37% had a medical bill sent to collections. The study also found that 57% of employees had delayed medical care because of cost, with 26% doing so within the past year. EBRI found that clear, plain-language information about supplemental benefits substantially increased employees’ interest in enrolling, suggesting that better benefits education could help workers make more informed coverage decisions.

Study Examines Costs and Benefits of Out-of-Pocket Caps in Traditional Medicare

A JAMA Health Forum study found that introducing annual out-of-pocket caps in Traditional Medicare could reduce beneficiaries’ financial burden and encourage enrollment shifts from Medicare Advantage, but increase federal spending by $39 – $96 billion annually, depending on the cap. The findings highlight differences in financial protections and benefit design between Traditional Medicare and Medicare Advantage, where V-BID principles have been implemented to promote high-value care.

Rising Healthcare Spending Drives 91% of Insurance Premium Growth

A JAMA Health Forum study found that rising spending on medical care accounted for 91% of private health insurance premium increases between 2011 and 2024. During this period, average annual premiums rose 78.4% ($3,143), largely reflecting higher spending on healthcare services rather than increases in insurer profit and administrative costs. The findings highlight the importance of addressing healthcare spending to improve insurance affordability.

Commonwealth Fund Finds Nearly Half of Working-Age Adults Inadequately Insured

A new Commonwealth Fund survey found that 21% of working-age adults with private insurance reported that their insurer denied coverage for doctor-recommended care for themselves or a family member in the past year. Among those experiencing prior authorization denials, 41% said the denial delayed care, 28% said a health problem worsened, and 63% reported experiencing worry or anxiety. Nearly 70% of people who experienced a claim denial said it increased their household’s costs, while 43% said the denial led to medical debt they are still paying off. Only about half of people who experienced a denial appealed.

KFF Survey Finds Delayed Care Worsens Health for Adults With Chronic Conditions

A KFF survey found that 27% of adults ages 18–64 managing three or more health conditions reported worsening health after skipping or delaying care. Among adults treated for specific conditions, worsening health due to delayed or forgone care was reported by 32% of those with mental health conditions, 29% with lung disease, 24% with cardiovascular disease, 21% with diabetes, and 18% with cancer.

Study Links Medical Debt to Advanced Cancer Diagnoses

A JAMA Network Open study of 2,958 U.S. counties found that communities with higher rates of medical debt in collections also had higher rates of late-stage diagnoses for lung, colorectal, cervical, and several other cancers. The findings suggest that financial barriers to healthcare may contribute to delayed cancer screening and diagnosis, potentially limiting opportunities for early detection and treatment.

KFF Finds Individual Health Insurance Enrollment Fell 18% in 2026

A new KFF analysis found that individual health insurance enrollment, primarily through Affordable Care Act (ACA) Marketplaces, declined 18% between 2025 and 2026, dropping by approximately 4.7 million enrollees. The decline coincided with the expiration of enhanced federal premium tax credits, which raised monthly premiums for many consumers and created additional financial barriers to maintaining coverage.

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