Pricey prescriptions and nagging medical costs are swamping some insurers and employers now. Patients may start paying for it next year.
Health insurance will grow more expensive in many corners of the market in 2026, and coverage may shrink. That could leave patients paying more for doctor visits and dealing with prescription coverage changes.
Price increases could be especially stark in individual coverage marketplaces, where insurers also are predicting the federal government will end some support that helps people buy coverage.
“We’re in a period of uncertainty in every health insurance market right now, which is something we haven’t seen in a very long time,” said Larry Levitt, an executive vice president at the nonprofit KFF, which studies health care.
In conference calls to discuss recent earnings reports, insurers ticked off a list of rising costs: More people are receiving care. Visits to expensive emergency rooms are rising, as are claims for mental health treatments.
Insurers also say more healthy customers are dropping coverage in the individual market. That leaves a higher concentration of sicker patients who generate claims.
Enrollment in the Affordable Care Act’s insurance marketplaces swelled the past few years. But a crackdown on fraud and a tightening of eligibility verifications that were loosened during the COVID-19 pandemic makes it harder for some to stay covered, Jefferies analyst David Windley noted.
People who use little care “are disappearing,” he said.
Prescription drugs pose another challenge, especially popular and expensive diabetes and obesity treatments sometimes called GLP-1 drugs. Those include Ozempic, Mounjaro, Wegovy and Zepbound.
“Pharmacy just gives me a headache, no pun intended,” said Vinnie Daboul, Boston-based managing director of the employee benefits consultant RT Consulting.
New gene therapies that can come with a one-time cost of more than $2 million also are having an impact, insurance brokers say. Those drugs, which target rare diseases, and some newer cancer treatments are part of the reason Sun Life Financial covered 47 claims last year that cost over $3 million.
The financial services company covers high-cost claims for employers that pay their own medical bills. Sun Life probably had no claims that expensive a decade ago and maybe “a handful at best” five years ago, said Jen Collier, president of health and risk solutions.
Some of these drugs are rarely used, but they cause overall costs to rise. That raises insurance premiums.
“It’s adding to medical (cost growth) in a way that we haven’t seen in the past,” Collier said.
Price hikes will be most apparent on the Affordable Care Act’s individual coverage marketplaces. Insurers there are raising premiums around 20% in 2026, according to KFF, which has been analyzing state regulatory filings.
But the actual hike consumers see may be much bigger. Enhanced tax credits that help people buy coverage could expire at the end of the year, unless Congress renews them.
If those go away, customer coverage costs could soar 75% or more, according to KFF.
Business owner Shirley Modlin worries about marketplace price hikes. She can’t afford to provide coverage for the roughly 20 employees at 3D Design and Manufacturing in Powhatan, Virginia, so she reimburses them $350 a month for coverage they buy.
Modlin knows her reimbursement only covers a slice of what her workers pay. She worries another price hike might push some to look for work at a bigger company that offers benefits.
“My employee may not want to go to work for a large corporation, but when they consider how they have to pay their bills, sometimes they have to make sacrifices,” she said.
Costs also have been growing in the bigger market for employer-sponsored coverage, the benefits consultant Mercer says. Employees may not feel that as much because companies generally pay most of the premium.
But they may notice coverage changes.
About half the large employers Mercer surveyed earlier this year said they are likely or very likely to shift more costs to their employees. That may mean higher deductibles or that people have to pay more before they reach the out-of-pocket maximum on their coverage.
For prescriptions, patients may see caps on those expensive obesity treatments or limits on who can take them.
Some plans also may start using separate deductibles for their pharmaceutical and medical benefits or having patients pay more for their prescriptions, Daboul said.
Coverage changes could vary around the country, noted Emily Bremer, president of a St. Louis-based independent insurance agency, The Bremer Group.
Employers aren’t eager to cut benefits, she said, so people may not see dramatic prescription coverage changes next year. But that may not last.
“If something doesn’t give with pharmacy costs, it’s going to be coming sooner than we’d like to think,” Bremer said.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Pages from the U.S. Affordable Care Act health insurance website healthcare.gov are seen on a computer screen in New York on Tuesday, Aug. 19, 2025. (AP Photo/Patrick Sison)
ATLANTA (AP) — Donald Trump would not be the first president to invoke the Insurrection Act, as he has threatened, so that he can send U.S. military forces to Minnesota.
But he'd be the only commander in chief to use the 19th-century law to send troops to quell protests that started because of federal officers the president already has sent to the area — one of whom shot and killed a U.S. citizen.
The law, which allows presidents to use the military domestically, has been invoked on more than two dozen occasions — but rarely since the 20th Century's Civil Rights Movement.
Federal forces typically are called to quell widespread violence that has broken out on the local level — before Washington's involvement and when local authorities ask for help. When presidents acted without local requests, it was usually to enforce the rights of individuals who were being threatened or not protected by state and local governments. A third scenario is an outright insurrection — like the Confederacy during the Civil War.
Experts in constitutional and military law say none of that clearly applies in Minneapolis.
“This would be a flagrant abuse of the Insurrection Act in a way that we've never seen,” said Joseph Nunn, an attorney at the Brennan Center for Justice's Liberty and National Security Program. “None of the criteria have been met.”
William Banks, a Syracuse University professor emeritus who has written extensively on the domestic use of the military, said the situation is “a historical outlier” because the violence Trump wants to end “is being created by the federal civilian officers” he sent there.
But he also cautioned Minnesota officials would have “a tough argument to win” in court, because the judiciary is hesitant to challenge “because the courts are typically going to defer to the president” on his military decisions.
Here is a look at the law, how it's been used and comparisons to Minneapolis.
George Washington signed the first version in 1792, authorizing him to mobilize state militias — National Guard forerunners — when “laws of the United States shall be opposed, or the execution thereof obstructed.”
He and John Adams used it to quash citizen uprisings against taxes, including liquor levies and property taxes that were deemed essential to the young republic's survival.
Congress expanded the law in 1807, restating presidential authority to counter “insurrection or obstruction” of laws. Nunn said the early statutes recognized a fundamental “Anglo-American tradition against military intervention in civilian affairs” except “as a tool of last resort.”
The president argues Minnesota officials and citizens are impeding U.S. law by protesting his agenda and the presence of U.S. Immigration and Customs Enforcement officers and Customs and Border Protection officers. Yet early statutes also defined circumstances for the law as unrest “too powerful to be suppressed by the ordinary course” of law enforcement.
There are between 2,000 and 3,000 federal authorities in the Minneapolis-St. Paul metro area, compared to Minneapolis, which has fewer than 600 police officers. Protesters' and bystanders' video, meanwhile, has shown violence initiated by federal officers, with the interactions growing more frequent since Renee Good was shot three times and killed.
“ICE has the legal authority to enforce federal immigration laws,” Nunn said. “But what they're doing is a sort of lawless, violent behavior” that goes beyond their legal function and “foments the situation” Trump wants to suppress.
“They can't intentionally create a crisis, then turn around to do a crackdown,” he said, adding that the Constitutional requirement for a president to “faithfully execute the laws” means Trump must wield his power, on immigration and the Insurrection Act, “in good faith.”
Courts have blocked some of Trump's efforts to deploy the National Guard, but he'd argue with the Insurrection Act that he does not need a state's permission to send troops.
That traces to President Abraham Lincoln, who held in 1861 that Southern states could not legitimately secede. So, he convinced Congress to give him express power to deploy U.S. troops, without asking, into Confederate states he contended were still in the Union. Quite literally, Lincoln used the act as a legal basis to fight the Civil War.
Nunn said situations beyond such a clear insurrection as the Confederacy still require a local request or another trigger that Congress added after the Civil War: protecting individual rights. Ulysses S. Grant used that provision to send troops to counter the Ku Klux Klan and other white supremacists who ignored the 14th and 15th amendments and civil rights statutes.
During post-war industrialization, violence erupted around strikes and expanding immigration — and governors sought help.
President Rutherford B. Hayes granted state requests during the Great Railroad Strike of 1877 after striking workers, state forces and local police clashed, leading to dozens of deaths. Grover Cleveland granted a Washington state governor's request — at that time it was a U.S. territory — to help protect Chinese citizens who were being attacked by white rioters. President Woodrow Wilson sent troops to Colorado in 1914 amid a coal strike after workers were killed.
Federal troops helped diffuse each situation.
Banks stressed that the law then and now presumes that federal resources are needed only when state and local authorities are overwhelmed — and Minnesota leaders say their cities would be stable and safe if Trump's feds left.
As Grant had done, mid-20th century presidents used the act to counter white supremacists.
Franklin Roosevelt dispatched 6,000 troops to Detroit — more than double the U.S. forces in Minneapolis — after race riots that started with whites attacking Black residents. State officials asked for FDR's aid after riots escalated, in part, Nunn said, because white local law enforcement joined in violence against Black residents. Federal troops calmed the city after dozens of deaths, including 17 Black residents killed by local police.
Once the Civil Rights Movement began, presidents sent authorities to Southern states without requests or permission, because local authorities defied U.S. civil rights law and fomented violence themselves.
Dwight Eisenhower enforced integration at Central High School in Little Rock, Arkansas; John F. Kennedy sent troops to the University of Mississippi after riots over James Meredith's admission and then pre-emptively to ensure no violence upon George Wallace's “Stand in the Schoolhouse Door” to protest the University of Alabama's integration.
“There could have been significant loss of life from the rioters” in Mississippi, Nunn said.
Lyndon Johnson protected the 1965 Voting Rights March from Selma to Montgomery after Wallace's troopers attacked marchers' on their first peaceful attempt.
Johnson also sent troops to multiple U.S. cities in 1967 and 1968 after clashes between residents and police escalated. The same thing happened in Los Angeles in 1992, the last time the Insurrection Act was invoked.
Riots erupted after a jury failed to convict four white police officers of excessive use of force despite video showing them beating a Rodney King, a Black man. California Gov. Pete Wilson asked President George H.W. Bush for support.
Bush authorized about 4,000 troops — but after he had publicly expressed displeasure over the trial verdict. He promised to “restore order” yet directed the Justice Department to open a civil rights investigation, and two of the L.A. officers were later convicted in federal court.
President Donald Trump answers questions after signing a bill that returns whole milk to school cafeterias across the country, in the Oval Office of the White House, Wednesday, Jan. 14, 2026, in Washington. (AP Photo/Alex Brandon)
