What a trial drug cost one family, the case for starting cancer support care earlier, and rising bills for insurance buyers and the country.
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Daraxonrasib gave Bobby Senaha about 10 good months with pancreatic cancer. His family flew from Hawaii to Texas every 21 days for it. story 1 ↓
Head and neck cancer patients who got support care during radiation: 60% alive and cancer-free at three years, versus 39%. The study was observational. story 2 ↓
ACA sign-up opens Nov. 1 with ID checks, fewer brokers, a 15% premium rise and a $12,000 out-of-pocket cap. story 3 ↓
US health spending hit $5.3 trillion in 2024, or $15,474 a person and 18% of GDP. Actuaries project 20% by 2032. story 4 ↓
US measles cases are more than double last year's. Pennsylvania alone has at least 1,338 confirmed cases across 44 counties.
1/4STAT· STAT Staff· Oct 23
A widow describes what daraxonrasib meant for her husband's pancreatic cancer
At the STAT Summit, Dana Senaha described her late husband's time in an early trial of daraxonrasib, a newly approved pancreatic cancer drug. It worked fast and gave him about 10 good months, but getting it took enormous family resources.
Why it matters · Trial results report median survival. This account shows what a few extra months look like for one patient: the side effects, the eventual resistance, and how hard it was just to get to the drug.
Know this first
Context from the editor, not the article · 27 sec
1 · Why pancreatic cancer is hard
Most pancreatic cancers are found after they have spread, and standard chemotherapy buys only months. Roughly 90% carry a mutation in the KRAS gene, a growth switch that was long considered impossible to target with drugs.
2 · What daraxonrasib targets
Daraxonrasib, developed by Revolution Medicines, blocks the active 'on' form of RAS proteins, including mutant KRAS. Earlier KRAS drugs hit only one specific mutation that is rare in pancreatic cancer.
3 · Phases and expanded access
Phase 1 trials test a new drug in a small group of patients, mainly to check safety and find the dose. Expanded access is an FDA pathway that lets patients outside a trial get an unapproved drug.
2/4The Conversation: Health· Marci Lee Nilsen, Professor of Otolaryngology, University of Pittsburgh· Oct 22
Head and neck cancer patients did better with support care starting during radiation
University of Pittsburgh researchers found that head and neck cancer patients who visited a support clinic before radiation ended were more likely to finish treatment on time and to be alive and cancer-free three years later. The study doesn't prove the clinic caused this.
Why it matters · Most survivorship care starts only after treatment ends. If the link is causal, starting it earlier is a cheap change that could improve both how patients get through treatment and whether they survive.
Know this first
Context from the editor, not the article · 30 sec
1 · What survivorship care is
Services that cover a cancer patient's physical, emotional, social and practical needs beyond the tumor itself: rehabilitation, nutrition, mental health, care coordination. Clinicians count someone as a survivor from diagnosis onward, but this care usually starts after treatment ends.
2 · Why radiation timing matters
In head and neck cancer, radiation usually runs five to seven weeks, often alongside chemotherapy. Breaks or delays that stretch the course are well known to lower tumor control, because cancer cells can regrow between doses.
3 · Accreditation shapes the default
3/4KFF Health News· Julie Appleby· Oct 23
ACA open enrollment for 2027: ID checks, fewer brokers, 15% premium rise
Federal regulators are adding identity checks and freezing new insurance brokers for 2027 Affordable Care Act sign-ups. Premiums are set to rise about 15%, and many lawfully present immigrants lose their subsidies.
Why it matters · Millions of people who buy their own insurance face more paperwork, fewer helpers and higher potential costs. Anyone who skips comparing plans or starts late risks a gap in coverage or overpaying.
Know this first
Context from the editor, not the article · 29 sec
1 · The ACA marketplaces
People without job-based insurance can buy plans on Affordable Care Act exchanges. The federal site, healthcare.gov, serves 29 states, and the rest run their own. Income-based tax credits lower monthly premiums. Many people enroll through commissioned agents or brokers.
2 · Enhanced subsidies expired
From 2021, Congress made the tax credits more generous and removed the income cap. That expansion ended after 2025. The original rules came back: smaller credits and none above four times the federal poverty level.
3 · Broker fraud problem
Rogue agents have enrolled people, or switched their plans, without consent so they can collect commissions. Zero- or low-premium plans are easy targets because the person may never see a bill. This is why CMS is tightening controls.
4/4KFF Health News· Lydia Zuraw and Renuka Rayasam· Oct 23
US health spending reached $5.3 trillion in 2024, 18% of the economy
KFF Health News went through federal spending data: the US spent $5.3 trillion on health care in 2024, $15,474 per person. The reporters blame rising prices more than sicker patients, and costs keep outpacing the economy.
Why it matters · Spending growth decides what premiums, deductibles and public programs cost. Recent federal policy has mostly moved that cost between payers rather than cutting it.
Know this first
Context from the editor, not the article · 29 sec
1 · Where the numbers come from
The National Health Expenditure Accounts, compiled each year by actuaries at the Centers for Medicare & Medicaid Services, are the official tally of US health spending. They come out with a lag of roughly a year and include 10-year projections.
2 · Who pays, who finances
The accounts split payers, such as insurers, Medicare, Medicaid and patients paying directly, from financers: the households, businesses and governments whose premiums and taxes fund those payers. Money can move between financers while the total stays the same.
Bobby and Dana Senaha with their two sons; Bobby was an early daraxonrasib trial patient.
The FDA has approved 1, a pill that blocks RAS proteins. RAS proteins act as growth switches and are mutated in most pancreatic cancers. STAT calls the approval the biggest advance in decades against the disease. At last week's STAT Summit, Dana Senaha described what the drug meant for her husband, Bobby. He was one of the early trial patients whose results helped get it approved.
This is one patient's story. The article gives no trial results, survival figures or details of the approval.
A patient out of options
When Bobby joined the trial in San Antonio, Texas, he had already been through the standard treatments for advanced pancreatic cancer. He'd had 2, a four-drug chemotherapy combination; 3 (gemcitabine plus nab-paclitaxel); an attempt to remove the tumor surgically; and a different 4 trial. Phase 1 trials are early studies that mainly test safety and dose. His cancer was still growing. He slept much of the day and was on the maximum dose of oral pain medication.
A fast response, then resistance
Within 24 hours of the first dose he halved his pain medication.
By day three the couple walked more than three miles.
At six weeks, scans showed a 45% reduction in disease, and the cancer that had spread to his lungs had disappeared. He later stopped pain medication entirely.
The side effects were real: a painful rash that could crack and bleed, swelling and bleeding around his fingernails, and stomach and bowel problems that came and went. Even so, he felt better than on chemotherapy.
After 29 weeks his cancer developed resistance, which is common with targeted drugs. He died at home in Hawaii in August 2024. She counts about 10 more good months from the drug.
Getting the drug was the hard part
Every 21-day treatment cycle meant flights between Hawaii and Texas, plus clinic visits, scans and blood tests. Her parents looked after their two sons while they were away. Senaha notes they had excellent insurance, flexible jobs, medical knowledge and family support, and were still overwhelmed.
A friend later got the drug through 5, an FDA pathway that lets patients outside a trial get an unapproved drug, and now fills it at a local pharmacy. Senaha argues that approval doesn't settle the question of who can get it. She points to people on Hawaii's outer islands with no nearby specialists, and people who can't afford time off work or the medicine itself. The article doesn't address the drug's price, insurance coverage, or which patients the approval covers.
The news and the talk
The FDA has approved 1 for pancreatic cancer. STAT calls it the biggest advance in decades against one of the hardest cancers to treat. Daraxonrasib is a pill that blocks RAS proteins, which act as growth switches and are mutated in most pancreatic tumors. At last week's STAT Summit in Boston, Dana Senaha described something survival curves can't show. Her husband, Bobby, was one of the early trial patients who helped move the drug toward approval. STAT published her prepared remarks.
This is one patient's story, not trial data. The piece gives no response rates, survival figures or details from the approval. Readers should treat the numbers below as one man's experience, not as what a typical patient can expect.
Where Bobby started
By the time the family reached San Antonio, Texas, for the daraxonrasib trial, Bobby had already been through the main options for advanced pancreatic cancer. He'd had 2, a four-drug chemotherapy combination; 3, which pairs gemcitabine with nab-paclitaxel (Abraxane); an attempt to surgically remove the tumor; and a different 4 trial. Phase 1 trials are early studies that mainly test safety and dose. His cancer was still growing. He slept most of the day and was on the maximum dose of oral pain medication.
That is the hardest group to treat. After first- and second-line chemotherapy fail, the remaining options usually work poorly and briefly. This helps explain why his response stood out to the family.
What happened on the drug
Dana Senaha reports this timeline:
Within 24 hours of the first dose, his pain had dropped enough that he halved his pain medication.
By day three, the couple walked more than three miles along the San Antonio River Walk.
At six weeks, scans showed a 45% reduction in disease, and the cancer that had spread to his lungs had disappeared.
Eventually he stopped taking pain medication altogether.
He stayed on the trial for 29 weeks. Then, in her words, his cancer "mutated and began to evade the treatment." This is 5, a common pattern with targeted cancer drugs: the tumor cells that survive find another route around the blocked pathway. He then tried another chemotherapy while looking for another trial. In early August 2024 his condition got worse quickly. After two weeks in hospital he died at home in Hawaii on Aug. 25, 2024. She counts about 10 more good months from the drug.
A big early response followed by resistance within months is the usual story for targeted drugs in advanced cancer. It's why approvals in this disease are measured in added months of median survival, not cures. The article doesn't say how long responses usually last in trials, or how Bobby compared with other patients.
The side effects
The drug was not easy to take. Bobby developed a painful rash that could crack open and bleed, swelling and bleeding around his fingernails, and stomach and bowel problems that came and went. Skin and nail damage is a known effect of drugs that block the RAS growth pathway, because healthy skin cells depend on the same signals. Even so, she says he felt better than he had on chemotherapy. He had less pain and more energy, and he could run, travel, work and spend time with their two sons. "For Bobby, the side effects were the price of getting his life back," she said.
What it took to get there
Her main point is about access. Trial treatment ran in 21-day cycles. Each cycle meant flights between Hawaii and San Antonio, clinic visits, scans and blood tests. Her parents looked after the boys while they were away. She lists what the family had going for them: excellent insurance, flexible jobs, medical knowledge, supportive doctors, help from family and a community behind them. "Even with all of that, we were overwhelmed."
Early trials run at a small number of specialist cancer centers. So who can take part depends on where people live, whether they can travel, and whether they can afford time off work. Those are the same factors that later shape who gets the approved drug.
After approval
She points to a friend, Peter, as the payoff of the trials. He got daraxonrasib through 6, the FDA pathway for unapproved drugs, and now picks it up at his local pharmacy. Senaha argues that approval doesn't settle the question of who gets the drug. Patients may still miss out if they can't afford it, live far from cancer specialists, or struggle with insurance and the health care system. She names people on Hawaii's outer islands who have no nearby specialists or trials, and people who can't take time off work or pay for their medicines.
What the piece leaves open
The article doesn't give the drug's price, insurance coverage, which patients it's approved for, or the trial results behind the approval. It also doesn't say what treatment options remain once resistance develops. Those are the questions that decide how much "the biggest advance in decades" changes things for a typical patient. One patient's strong response can't answer them.
Remember
A 45% shrinkage at six weeks is one patient's result, not a typical trial outcome; the article gives no trial data.
Bobby's response lasted 29 weeks before resistance set in, which is the usual pattern for targeted drugs in advanced cancer.
Trial access required flights from Hawaii every 21 days; even a well-resourced family found it overwhelming.
The American College of Surgeons Commission on Cancer accredits US cancer programs. It requires hospitals to offer at least three survivorship services after initial treatment, which helps explain why most programs begin this care only once treatment is over.
alive and cancer-free
Alive with no detected recurrence of the cancer, an outcome often called disease-free survival.
Head and neck radiation causes pain, mouth sores and swallowing problems that can interrupt treatment.
Patients with head and neck cancer who started 1 before their radiation ended did markedly better than those who didn't, according to a University of Pittsburgh study in JAMA Otolaryngology–Head & Neck Surgery. Survivorship care means support for a cancer patient's physical, emotional and practical needs beyond the tumor itself. The lead researcher is careful to say the study shows an association and doesn't prove the care caused the difference.
Why timing is the question
Clinicians count someone as a cancer survivor from the day of diagnosis. Yet most survivorship care, such as rehabilitation, nutrition and mental health support, starts only after treatment ends. One reason is the accreditation rules of the 2, which require survivorship services after initial treatment.
In head and neck cancer, the hardest stretch comes earlier. Patients often get five to seven weeks of daily radiation, frequently with chemotherapy. The treatment causes pain, mouth sores, burns, swallowing problems and weight loss, which can force breaks in treatment or hospital stays. Breaks matter because a longer radiation course is known to give cancer cells more time to regrow.
What the clinic does
At the 3 (University of Pittsburgh Medical Center) clinic run by author Marci Lee Nilsen, patients see surgeons, nurses, swallowing therapists, a physical therapist, dental staff and a dietitian in one same-day visit, usually for a single copay. A shared care plan then goes to the patient, their oncologists and their primary care doctor. The clinic was first built for people who had finished treatment and later opened to patients before radiation.
The numbers
Across 471 patients, comparing those first seen before radiation ended with those who weren't:
Finished radiation on time: 62% vs 48%
Alive and cancer-free at three years: 60% vs 39%
The survival gap held after the team accounted for on-time completion. That suggests avoiding treatment breaks doesn't fully explain the difference.
Caveats
The study was 4. Patients who reach a support clinic early may be healthier, better supported or less sick to begin with. Patients whose treatment fell apart early also had less chance to visit, which could tilt the comparison. The article doesn't report group sizes or which other factors were adjusted for. Nilsen directs the clinic she studied, which she discloses. Her team plans a larger 5 to test the idea.
The wider gap
A 2024 survey of 384 accredited US cancer programs found that only 1 in 5 estimated that most eligible patients get survivorship care. Among head and neck cancer clinicians, only about half address anxiety and depression, and fewer than 1 in 3 address sleep or body image.
A team at the University of Pittsburgh reports that patients with head and neck cancer who started 1 before their radiation ended were more likely to finish radiation on time. They were also more likely to be alive and free of cancer three years later. The study appeared in JAMA Otolaryngology–Head & Neck Surgery. Marci Lee Nilsen, a nurse-scientist who directs the clinic where the study took place, describes it in The Conversation. The design is 2, and she says plainly that the results suggest a benefit without proving one.
The problem: support arrives after the hardest part
Survivorship care covers a cancer patient's needs beyond the tumor: swallowing, nutrition, dental health, physical function, mood and coordination among doctors. Clinicians count someone as a survivor from the day of diagnosis. In practice, though, most of this care starts only once initial treatment is over. Nilsen points to one reason. The 3, which accredits US cancer programs, requires hospitals to offer at least three survivorship services after patients finish initial treatment. That standard anchors the care to the end of treatment.
Head and neck cancer shows the cost of that timing clearly. Patients often go through five to seven weeks of daily radiation, frequently combined with chemotherapy. The side effects include pain, mouth sores, skin burns, trouble swallowing and weight loss. Together these can force breaks in treatment or send patients to hospital, and many of them persist or get worse years later. Patients report significant unmet needs before and during treatment, when no survivorship service is yet involved.
Interruptions matter beyond comfort. It is well established in head and neck oncology that stretching out a course of radiation lowers the chance of controlling the tumor, because cancer cells can regrow between doses. Anything that helps patients get through all their sessions on schedule could plausibly affect survival.
What the clinic does
The 4 (University of Pittsburgh Medical Center) Head and Neck Cancer Survivorship Clinic puts several specialists in one place: surgeons and nurses, swallowing therapists, a physical therapist, a dental team and a dietitian. A patient can see all of them on the same day, usually for a single copay. After the visit, a written care plan goes to the patient, their oncology team and their primary care clinician, so everyone works from the same picture. The clinic is meant to follow patients over time, not to offer a one-off consultation.
The clinic was first built for people who had finished treatment. It later opened to patients before radiation. An earlier analysis by the team linked pre-radiation visits with better quality of life and fewer symptoms.
The results
The new analysis covered 471 patients. It compared those first seen at the clinic before they completed radiation with those who were not:
Outcome
Seen before radiation ended
Not seen before radiation ended
Finished radiation on time
62%
48%
Alive and cancer-free at 3 years
60%
39%
The survival gap is 21 percentage points, which is large. Nilsen notes that it held up after the team accounted for whether patients finished radiation on time. So the benefit doesn't seem to come only from helping patients avoid treatment breaks. The article doesn't say what that other pathway might be. Possibilities include better nutrition, catching complications earlier or closer follow-up, but these are guesses, not findings.
Why caution is warranted
This is an association, not a controlled test. The article doesn't report how many patients were in each group or which other factors the analysis adjusted for. It also gives no hazard ratios or confidence intervals. Several well-known biases could produce a gap like this without the clinic causing it:
Selection. Patients who get referred or show up early may be fitter, have better social support or insurance, live closer, or have less advanced disease. Each of these predicts better survival on its own.
Timing-based grouping. Patients are grouped by whether a visit happened before radiation ended. Someone whose treatment collapsed early, through severe toxicity or hospital admission, had less chance to make that visit. That could tilt the comparison toward the early-visit group.
Conflict of interest. Nilsen directs the clinic being evaluated. She discloses this, along with funding from the National Institutes of Health and the Gordon and Betty Moore Foundation.
The team plans a larger 5. It will test whether starting survivorship care before radiation helps patients finish on time and keep their quality of life, and it will look at how care teams handle coordination and referrals. A randomized design would deal with most of the problems above.
The wider gap
Even care after treatment is patchy. A 2024 survey of 384 Commission on Cancer–accredited facilities found that only 1 in 5 programs estimated that most of their eligible patients receive survivorship care. In head and neck cancer, nearly all clinicians routinely check for recurrence and assess swallowing and thyroid function. About half address anxiety and depression, and fewer than 1 in 3 address body image or sleep. Nilsen names the barriers: patients who never hear about services, missing referrals, and centers without enough dedicated staff time across the specialties involved.
What's open
The main question is whether the effect is real and causal, and only the planned trial can answer it. Others follow. Would a multidisciplinary clinic like Pittsburgh's work in hospitals with fewer specialists? Would accreditation standards need to change to reward care during treatment, not just after it? Nilsen argues that bringing rehabilitation and supportive-care specialists in at the start should become routine. Her advice to patients and families is not to wait to ask for that support.
Remember
Patients seen early had a 21-point survival advantage that on-time radiation completion alone didn't explain.
Who gets to a clinic early is not random, so healthier or better-supported patients may account for the gap.
Only 1 in 5 accredited US cancer programs say most eligible patients receive any survivorship care.
Open enrollment for 2027 1 (ACA) coverage starts Nov. 1 in most states. Idaho, Connecticut and Massachusetts open earlier. KFF Health News reporter Julie Appleby says shoppers face more ID checks, fewer brokers, higher costs and new limits on subsidies for immigrants. Enrollment is expected to keep falling, mainly because the enhanced subsidies ended after 2025. The Trump administration credits its fraud crackdown, including the August cancellation of 760,000 policies it suspected were improper.
Identity checks
The new rules come from 2 (the Centers for Medicare & Medicaid Services, which runs the 3). They apply only to people who use an agent or broker on the federal marketplace, which serves 29 states. Every such person must approve their agent with a one-time code sent by text, email or automated call.
People CMS labels "high-risk" must first prove their identity through a service such as the credit bureau 4. That group is:
first-time applicants
enrollees moving to another state
anyone switching to a new agent
anyone paying $30 a month or less
The logic is that rogue agents impersonate consumers when switching plans. Cheap plans also make it easy to enroll someone who never sees a bill. Some bad agents even pay the small premium themselves and keep the commission.
Pennsylvania agency head Joshua Brooker estimates up to 1 in 5 consumers may need the extra check. Georgetown researcher Stacey Pogue notes that real people can fail if they have no credit file, have moved or have changed their names.
A freeze on new brokers
Agents who were not registered for 2026 cannot help with 2027 sign-ups until February at the earliest, after enrollment closes. CMS says new agents caused a disproportionate share of compliance problems. Florida broker Jason Fine supports the goal but expects short-term chaos. Small agencies can't hire seasonal staff, while big call centers with year-round staff gain. Two agent groups have sued, one saying the freeze blocks 19,000 agents. Pogue's advice: book broker appointments early.
Costs
Premiums are set to rise about 15%, after 26% last year. Subsidies track the second-cheapest silver plan in each area, so they rise as premiums rise. Analyst Louise Norris expects affordability for most subsidized people to stay "about the same." Subsidies stop above four times the poverty level: $63,840 for a single person and $109,280 for a family of three.
The annual out-of-pocket cap rises 13%, to $12,000 for an individual and $24,000 for a family. Experts advise against auto-renewing. Compare premiums and deductibles, since some insurers, including Cigna, have pulled out of some areas.
Under last year's 5, refugees, asylees, H-1B visa holders and many other lawfully present immigrants lose subsidies. Green-card holders still qualify.
Open enrollment for 2027 1 (ACA) coverage starts Nov. 1 in most states. Idaho, Connecticut and Massachusetts open earlier, and some states already let people "window shop" rates. KFF Health News reporter Julie Appleby lists what is different this year:
tighter identity checks for people who enroll through agents
a freeze on brokers who are new to ACA sales
another double-digit rise in premiums
higher caps on out-of-pocket costs
new limits on which immigrants can get subsidies
Enrollment is expected to keep falling. Policy experts blame the end of the enhanced subsidies after 2025, which led millions to drop or lose coverage early this year. The Trump administration sees the decline as a win against fraud. It points to its August cancellation of 760,000 policies for enrollees it suspected were signed up improperly. A small number of those people have since regained coverage. The article does not say how many of the cancelled policies were actually fraudulent, so the administration's claim can't be checked from this piece.
Identity checks for agent-assisted sign-ups
The Centers for Medicare & Medicaid Services (2), the federal agency that runs the marketplace, set out the new rules in a FAQ. They apply only to people who use an agent or broker on the 3, which serves 29 states. State-run exchanges have their own rules, and the article says they have mostly been better at stopping fraudulent sign-ups.
Step one applies to everyone using an agent. The consumer gets a one-time code or link, by text, email or automated call, from the private enrollment platform the agent uses. Entering it authorizes that specific agent to enroll the person or change their plan. Returning customers whose contact details are wrong or out of date must first fix them by calling the marketplace or applying online themselves.
Step two applies only to people CMS labels "high-risk." They must prove their own identity before they can authorize an agent. The groups are:
first-time applicants
current enrollees whose application involves moving to a different state
anyone working with a new or different agent
anyone whose monthly premium is $30 or less
Pennsylvania agency head Joshua Brooker explains the logic. Someone who changes state or broker "could be a broker trying to impersonate a consumer." The $30 cutoff targets plans with low or no premiums, where the person may never get a bill and so never notices an unauthorized enrollment. Brooker says some rogue agents pay the small premium themselves and still profit from the commission.
The check is run by a CMS-approved third party such as the credit bureau 4, which asks questions only the real person should be able to answer. Anyone who fails can call Experian's help desk, or create a healthcare.gov account and upload a driver's license, passport, immigration papers or other ID.
Brooker worries that "up to 1 in 5 consumers" will need this extra step and some will give up and go uninsured. That figure is his estimate, not a CMS number. Stacey Pogue of Georgetown University's Center on Health Insurance Reforms says real people can fail credit-based questions because they have no credit file, have moved or have changed their names. She calls the rules a possibly "appropriate response" to fraud that also adds hurdles.
A freeze on new brokers
In September, CMS barred agents who were not registered with the federal marketplace in 2026 from helping with 2027 enrollments until February at the earliest. That is after open enrollment ends. CMS says newly registered agents accounted for a disproportionate share of "significant compliance concerns" in 2026. It has also removed "hundreds" of non-compliant agents and brokers this year.
Florida broker Jason Fine has reported rogue agents who switched his clients' plans without permission, and he backs the goal. But he expects short-term "chaos." Small agencies like his, with about five core staff, shrink after enrollment season and hire again in the fall. He planned to add up to 10 agents, but recruiters told him almost no one who was registered for 2026 is still available. Fine argues the rule unintentionally favors large call centers that keep 25 to 40 people on staff all year. Some of those call centers did the kind of marketing regulators blamed for unauthorized switching.
Two agent groups have sued:
The National Association of Benefits and Insurance Professionals filed on Oct. 15, saying the freeze unfairly blocks 19,000 agents.
Health Agents for America filed on Oct. 21, asking for a temporary restraining order.
Pogue's practical advice: anyone who relies on a broker should book an appointment early, because there will be fewer of them.
Costs
Most people buying 2027 coverage will still get a subsidy, just a smaller one than before the enhancements ended. The subsidy is tied to the 5, the second-lowest-cost silver plan where you live. In general terms, the tax credit covers the gap between the benchmark premium and a set share of your income. So when the benchmark premium rises, the credit rises with it.
An illustrative example, with made-up numbers: if your expected contribution is $200 a month and the benchmark plan goes from $600 to $690, your credit grows from $400 to $490. Your cost for the benchmark plan stays around $200.
That is why Louise Norris of HealthInsurance.org expects affordability for most subsidized people to stay "about the same" as this year. She adds: "That's not to say it's great."
Premiums are still rising. Last year's average increase of 26% was the biggest in years. It was partly driven by insurers' fear that healthier people would leave once the subsidies expired, along with rising medical costs, inflation and labor shortages. The 2027 increase is about 15%. For people above the income cutoff, there is no cushion. Subsidies stop at four times the 6, which this season means:
Household
Income cutoff
Single person
$63,840
Couple
$86,560
Family of three
$109,280
The 7 is also going up. It is the most an enrollee pays in deductibles, copays and coinsurance for in-network care in a year. It rises 13%:
2026
2027
Individual
$10,600
$12,000
Family
$21,200
$24,000
Households earning up to 2.5 times the poverty level have lower caps.
Agents advise against letting a plan renew automatically. Premiums and benefits change every year, even within the same plan. New insurers may offer cheaper options, while some insurers, including Cigna, have pulled out of all or part of their ACA areas. Compare deductibles as well as premiums.
Immigrants
The 8, passed last year, removes subsidy eligibility from many lawfully present immigrants. That includes H-1B visa holders, refugees, asylees, people with temporary protected status, and people with pending green-card applications. Three groups remain eligible:
green-card holders
certain Cuban and Haitian immigrants
citizens of Micronesia, the Marshall Islands and Palau
What's unresolved
The lawsuits could change the broker freeze in the middle of the season. There is no data yet on how many real applicants will fail identity checks or give up. And the article cannot say whether the drop in enrollment reflects less fraud or simply people priced out of coverage.
Remember
Owing $30 a month or less, switching agents, or moving states now triggers a separate identity check.
Because subsidies track the benchmark plan, many subsidized buyers are partly shielded from the 15% premium increase.
Out-of-pocket caps rise 13% in 2027, so auto-renewing without comparing plans could cost more.
Under the Affordable Care Act (ACA), people buying their own insurance get tax credits toward premiums. Congress made those credits larger during the pandemic. The article treats them as expired and talks about restoring them.
Cover graphic, apparently a flow chart showing how US health dollars move between funders and spending categories.
KFF Health News went through the federal government's health spending data. In 2024, the latest year available, the US spent $5.3 trillion on health care. That's more than $14.4 billion a day, $15,474 per person, and 18% of 1, the value of everything the economy produces.
Higher prices, fewer visits
Reporters Lydia Zuraw and Renuka Rayasam say per-person spending rose mainly because of higher prices, not because Americans are sicker. They cite the 2, a project comparing the US with similar wealthy countries. By its count, Americans have about half as many in-person doctor consultations per person as people in peer countries. "We pay more for less care," the authors write.
That matches years of research on high US prices. Still, visit counts are a rough measure of how much care people get, and the article doesn't split the growth into price, volume and aging.
Where it goes
Hospital care has been the largest spending category for more than two decades, and federal projections say it will stay that way. Retail prescription drugs, medicines bought at pharmacies, are projected to grow fastest, at 5.7% a year, slightly ahead of hospitals.
Who pays
The data separates payers from the people who fund them. Payers are private insurance, 3 (the federal program for people 65 and older), 4 (the program for low-income people), out-of-pocket costs and other programs. Households, governments and businesses fund those payers through premiums and taxes.
The split matters because, the authors argue, many federal proposals move costs between funders without lowering them. The 5, the 2025 tax-and-spending law, moved more spending onto households, which the authors say hits low-income patients hardest. Restoring the enlarged pandemic-era 6 premium subsidies would move costs back to government, which is funded disproportionately by wealthier taxpayers. Neither changes the total.
People told KFF Health News they're going without insurance, rationing medicines and putting off care. These are individual accounts, not survey results.
Growing faster than the economy
Federal actuaries project health care will reach 20% of GDP by 2032. "We're not going to be able to finance our way out of healthcare spending that's growing faster than GDP," says Harvard health-policy professor Michael Chernew. "We'll all end up with healthcare and no clothes or houses or cars."
The article diagnoses the problem but doesn't weigh fixes. It doesn't cover price regulation or drug-price negotiation, which aim to slow the growth itself rather than move who pays.
KFF Health News reporters Lydia Zuraw and Renuka Rayasam went through the federal government's health spending data for 2024, the latest year available. The US spent $5.3 trillion on health care that year. That works out to more than $14.4 billion a day, or over $10 million a minute. Spending per person averaged $15,474, and the total came to 18% of 1, the value of everything the economy produces.
The piece is short and mostly descriptive, built around the authors' charts. What it adds is a framing: why spending is high, who carries it, and why current policy fights mostly move the bill around instead of shrinking it.
Prices, not illness
The authors say per-person spending rose "not necessarily because we're sicker, but because of increased prices." As evidence they cite the 2, a joint project of the Peterson Center on Healthcare and KFF that compares the US with similar wealthy countries. By its count, Americans have about half as many in-person doctor consultations per person as people in peer countries. The authors sum it up: "we pay more for less care."
That fits a long line of health-economics research finding that US prices for hospital stays, physician services and drugs are well above those in other rich countries. Doctor visits are only one measure of how much care people get, though. The article doesn't break down how much of the 2024 increase came from price growth versus volume or an aging population. Treat the "prices, not sickness" claim as the authors' reading of the data, backed by outside research, not something this piece demonstrates.
Where the money goes
Hospital care has been the biggest spending category for more than 20 years, and federal projections say it will stay the biggest for the next decade. The fastest-growing category is retail prescription drugs, meaning medicines bought at pharmacies rather than given in hospitals or clinics. That spending is projected to grow 5.7% a year on average, a bit faster than hospital care. The article gives no dollar shares for each category beyond what its graphics show.
Who pays, and who really pays
The federal data separates two layers:
Sources of spending: private health insurance, 3 (the federal program for people 65 and older), 4 (the joint federal-state program for low-income people), out-of-pocket payments, and other programs.
Financers: households, governments, businesses and other private entities, which fund those sources through premiums, taxes and direct payments.
Here's an illustrative example (not from the article) of why the split matters. Say a family's $10,000 premium is paid half by a federal subsidy and half by the family. If the subsidy disappears, the plan still costs $10,000 and national spending doesn't change. The family's share doubles, though, and some families will drop coverage.
That's the article's main policy point: many federal proposals "focus on shifting costs from one funder to another rather than lowering them." It gives two examples:
The 5, the 2025 tax-and-spending law, moved more spending from government onto households, which the authors say increases the burden on low-income patients.
Restoring the pandemic-era ACA subsidies, the enlarged 6 premium tax credits, would move costs back to government. Federal revenue comes disproportionately from wealthier taxpayers.
Neither move changes the $5.3 trillion total. Each changes who pays it.
What it means for patients
According to the reporters, people say premiums and out-of-pocket costs are going up. They describe going without insurance, rationing medicines, seeing the doctor less and postponing procedures. These are reported accounts, not survey numbers. The article doesn't measure how common the behaviors are.
Outgrowing the economy
Federal actuaries project health spending will keep growing faster than the economy as a whole, reaching 20% of GDP by 2032, up from 18% in 2024. Two percentage points of GDP is a large shift of national income toward health care in under a decade.
Michael Chernew, a health-policy professor at Harvard Medical School, puts the limit bluntly: "We're not going to be able to finance our way out of healthcare spending that's growing faster than GDP. We'll all end up with healthcare and no clothes or houses or cars." His point is that changing the payer can't fix a growth rate. Only slower price or volume growth can.
What the article leaves open
The piece diagnoses the problem but doesn't weigh solutions. It doesn't cover price regulation, 7 (paying the same for a service whether a hospital or a doctor's office provides it), Medicare drug-price negotiation, or hospital consolidation. Those are the main options for bending the growth curve rather than shifting it. It also doesn't say how much the One Big Beautiful Bill Act or the subsidy lapse changed household spending, or say whether the 2032 projection already accounts for those laws.
Remember
Changing who pays, such as households or government, leaves total health spending unchanged. Only slower price or volume growth lowers it.
Retail prescription drugs, not hospitals, are projected to be the fastest-growing spending category, at 5.7% a year.
The claim that the US pays more for less care relies on visit counts, a rough measure of how much care people get.
